WNCDSA 2010 Camp & Enrichment Program [Scholarship Application]

Please fill out form completely.

* Child's Name

* Age

* Parent or Guardian Name

* Home Phone

* Cell Phone

* Mailing Address

* County

* My Child Has Down Syndrome (yes or no)

 

* Email

* Name of Camp-Enrichment Program

* Telephone

* Camp-Enrichment Program is Affiliated with

 

* Address of Program

* Type of Program (day or overnight)

* Dates Child will attend Program

 

* Name of One-on-One Assistant (if applicable)

 

 

Subject Scholarship Application
* Your comments

* Are you human?

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By submitting or mailing this application, the parents or guardian do, individually and jointly, release and hold harmless the Western North Carolina Down Syndrome Alliance, officers, directors, employees and volunteers from any and all claims, all actions, demands, costs and any other thing whatsoever arising out of camp or enrichment experience. We understand that the WNCDSA agrees to pay tuition to the camp-enrichment program chosen by the parent of guardian and attended by our child, and to pay the one-on-one assistant chosen by us as parents.

We also agree to furnish a photograph or description of the camp experience for use by the WNCDSA unless prior arrangements or exceptions are made.

Please click on Submit or print completed form and mail to WNCDSA, P.O. Box 421, Weaverville, NC 28787.