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Horsemanship Fee Assistance Application

• Camper Information

• Full Name*
  First Last
• Birth Date*
  Month

  Day

  Year
• Are you interested in fee assistance for horsemanship lessons?*
  • Yes
  • No
• Additional Info
  Please provide any additional info in regards to your request.
• Have you attended Camp Ernst previously?*
  • Yes
  • No

• ---

• Mailing Address*
  Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

• Parent Guardian Information

• Parent/Guardian #1*
  First Last
• Phone #1*
• Phone #1 Type*
  - select -HomeCellWork
• Phone #2*
• Phone #2 Type*
  - select -HomeCellWork
• Email*

• ---

• Parent/Guardian #2
  First Last
• Phone #1
• Phone #1 Type
  - select -HomeCellWork
• Phone #2
• Phone #2 Type
  - select -HomeCellWork
• Email

• Income Information

• Total Number of Adults and Children in Household*
  - select -123456+
• Total Household Gross Income Per Year*
  - select -$0 - $18,999$19,000 - $30,000$30,001 - $40,000$40,001 - $55,000$55,001-$65,000$65,001 +
  (Total household income including child-support, unemployment, public assistance, and other before deductions or “adjusted”/AGI on tax forms)
• Please explain why you want your child to take horseback riding lessons at Camp Ernst.*

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