Kids to Camp Scholarship

Child's Name(Required)

First Middle Initiial Last

Parent/Guardian's Full Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone(Required)

Secondary Phone

PARKS DIRECT Household #:

Email(Required)

Enter Email Confirm Email

2023 IRS Return Transcript

The following section is to be completed using the IRS Return Transcript. Please attach IRS Return Transcript to application. For more information on how to obtain your IRS Return Transcript, go to https://www.pgparks.com/activities-events/fee-assistance-scholarships

IRS Return Transcript(Required)

Max. file size: 100 MB.

Tax Year(Required)

Adjusted Gross Income:(Required)

Number of Family Members Listed on Transcript:(Required)

Requested Camp Dates & Locations

Camp Date (First Preference)(Required)

Camp Location & Camp Name (First Preference)(Required)

Camp Date (Second Preference)(Required)

Camp Location & Camp Name (Second Preference)(Required)

Camp Date (Third Preference)(Required)

Camp Location & Camp Name (Third Preference)(Required)

Participation Agreements

Agreement(Required)

If selected each scholarship recipient is required to agree to each of the below (either signature or check box):

Exhibit good sportsmanship throughout all PGPR activities

Agree to participate in promotional material which may include photography

Signature

Date(Required)

Receive an email copy of this form.

Yes

Hidden

Email address

This field is not part of the form submission.

Phone

This field is for validation purposes and should be left unchanged.