2019 Scott-Free Camper Application

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Thank you for your interest in the Scott-Free Scholarship Foundation!  Please fill in the following demographic information for your camper.

CAMPER INFORMATION
Child's Name [hereinafter "Camper"]



Person Completing This Form
Child's Date of Birth





Address






Legal Guardian




School / Grade Info



Preferred School Staff Contact


example: teacher, counselor, principal, etc

Camp Preferences


History

It is the intention of both The Scott-Free Scholarship Foundation and our camp partners to provide a wonderful summer camp opportunity for children who seek scholarship assistance. Each camp spot is very costly.  Once a camper family accepts a camp spot, it is a commitment and that camp spot immediately becomes unavailable for any other camper.  When a camper declines to attend an accepted camp spot at the last minute it becomes very costly both for Scott-Free and our designated camp partners.  A last minute cancellation becomes a wasted camp opportunity and is unable to be utilized by another child.  Once accepted; It is a commitment that must be honored by the camper families.  Unfortunately, Scott-Free must implement a rule which states:   If a camper family is a NO SHOW or cancels to attend camp without written confirmed/legitimate cause within 2 weeks of designated camp registration day; camper will no longer be eligible for a Scott-Free summer camp scholarship and all future Scott-Free summer camp scholarships will be forfeited.
Signature:





The Scott-Free Scholarship Foundation pairs at-risk children with unique camp environments, which will nurture already identified talents for some and allow discovery for others.  In keeping with that mission, The Scott-Free Scholarship Foundation requires information about what puts each child at-risk.

RISK ASSESSMENT



























24(A-F).    My child could benefit from:















ACCIDENT WAIVER AND RELEASE OF LIABILITY


I understand, acknowledge and agree that I am submitting the Camper (my minor child or ward) for a summer camp opportunity (hereinafter the "Camp Opportunity") from Journeys Urging Mammoth Possibilities d/b/a Scott-Free (hereinafter "Scott-Free"). By checking the "Yes" boxes below, I hereby take action for myself, the Camper, my executors, administrators, heirs, next of kin, successors, and assigns and agree to the following terms of this Accident Waiver and Release of Liability (hereinafter the "Agreement"):

Signature of Guardian/Parent (for minor Camper):   





Scott-Free makes every effort to get to know the children whom we serve.  Please be specific and answer the following questions about your child.

Questions for Parents:










Signature





It is recommended that parent and child work together to complete this section.

Camper Activity Interest List:

Please rate each activity according to how interested your child is in the activity.  Ratings are from Not At All Interested (1) to Very Interested (5).

(1) Not at all Interested (2) Slightly Interested (3) Somewhat Interested (4) Interested (5) Very Interested

(1) Not at all Interested (2) Slightly Interested (3) Somewhat Interested (4) Interested (5) Very Interested

(1) Not at all Interested (2) Slightly Interested (3) Somewhat Interested (4) Interested (5) Very Interested

(1) Not at all Interested (2) Slightly Interested (3) Somewhat Interested (4) Interested (5) Very Interested

(1) Not at all Interested (2) Slightly Interested (3) Somewhat Interested (4) Interested (5) Very Interested

(1) Not at all Interested (2) Slightly Interested (3) Somewhat Interested (4) Interested (5) Very Interested

(1) Not at all Interested (2) Slightly Interested (3) Somewhat Interested (4) Interested (5) Very Interested

(1) Not at all Interested (2) Slightly Interested (3) Somewhat Interested (4) Interested (5) Very Interested

(1) Not at all Interested (2) Slightly Interested (3) Somewhat Interested (4) Interested (5) Very Interested




Questions for the Camper:

This section should be completed by the camper.


Please complete the following questions so that Scott-Free can learn more about you and pair you with a camp that fits your interests.  














The Scott-Free Scholarship Foundation will need a copy of each applicant’s latest report card and a recent photograph.  The application will not be processed until these items are received.

Report Card / Photo


You may:

Mail the report card and/or photo to the following address:

The Scott-Free Scholarship Foundation

℅ Leigh White

120 Benning Circle

Clayton, NC 27527

✤For faster processing time, please upload the report card and picture.  Full electronic applications are preferred.  However, if you are not able to complete all parts of the application online,  mailed information is acceptable.

All applications must be complete and submitted by no later than 1/31/18.

Don’t forget to add Scott-Free to your email contacts!

Thank you again for your interest in Scott-Free.

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“Journeys Urging Mammoth Possibilities” d/b/a “Scott-Free” is a 501(c)(3) tax exempt non-profit organization. 282 W Millbrook Road, Raleigh, NC, 27609