2026 Scholarship Request Form for Kids Camp Registration Form

It is our goal at Camp Orchardville to ensure that no student is unable to participate in camp due to finances. To meet this goal, we work to keep camp costs as low as possible. We subsidize the cost of camp with contributions from Orchardville Church. We also give the opportunity for individuals to sponsor students who aren't financially able to pay the camp fee. We ask that you consider your personal resources and priorities before making a request; this will help our scholarship dollars go as far as possible. If you are unable to pay some or the entire camp fee, please don't let that stop your student from attending.

Please explain need for scholarship:

Camper Contact Info:

Grade entering Fall 2026:

3rd Grade 4th Grade 5th Grade

Camper's Name

Address

Phone

This address will receive a confirmation email

Date of Birth

Gender

Male Female

Church Camper Attends

Camper from your grade that you would like to room with (if possible)

Parent or Guardian's Name

Parent or Guardian's Work #

Emergency Contact Name

Emergency Phone #

Camp activites not permitted (E.g. swimming, sports)

List any Special Medical Problems or Allergies

Special Dietary Needs

Medical Info (REQUIRED)

Ins. Company

Policy Holder

Group Number

Ins. Phone #

List any medications that will be taken at camp:

Camp Orchardville Liability Release Form

By typing below, I hereby consent to let me child attend and participate in all activites at Camp Orchardville. This includes zip-lining, swimming, and ALL other activities. I give my permission for Orchardville Church and Camp Orchardville to transport my child to and from any camp activities off site. Also, I give my permission for the camp nurse to provide over the counter medication as needed. I understand that every precaution will be taken for the safety and well-being of my child, but in the event of an accident, Orchardville Church/Camp Orchardville along with its staff and volunteers, are hereby released from any and all liability.

Parent/Guardian type name below:

Parent/Guardian Name:

Please notify Orchardville Church at 618-835-2677 within 48 hours if your camper will not be able to attend Camp. This will give us time to notify those on our waiting list.

2026 Scholarship Request Form for Kids Camp Registration Form

Description

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