SCHOLARSHIP REQUEST INFORMATION

The churches and church members of Daniell Baptist Association often send in funds to be used to scholarship youth for Surge Camp.

The amount of scholarship award issued each year changes and cannot be predicted. This Scholarship Request is not a guarantee of camp fees paid.

Requirements:

Scholarship Requests are accepted until April 25, 2022.
Requests submitted after April 25 will not be reviewed.
The entire Surge Camp application must be competed.
Scholarship recipients must pay $25 toward their camp fees.

Notice of Award:

All scholarship requestees will be notified VIA EMAIL as to whether they are the recipient of the scholarship or not by May 5, 2022. **Please make sure the email address you provide is checked often**
Scholarship recipients have until May 12, 2022 to submit the $25 fee.
If the fee is not received by May 12 at 2:30 p.m., the scholarship will go to another requestee, without notice.

Camper & Parent Information

First Name^*

Last Name

Age^*

Gender^*

T‑Shirt Size (Adult Sizes Only)^*

Grade Just Completed^*

Parent/Guardian Name^*

Parent Cell Phone^*

Email^*

Address

Address Line 1 ^*

City ^*

State or Region ^*

Zip ^*

SCHOLARSHIP REQUEST INFORMATION

The churches and church members of Daniell Baptist Association often send in funds to be used to scholarship youth for Surge Camp. The amount of scholarship award issued each year changes and cannot be predicted. This Scholarship Request is not a guarantee of camp fees paid.

Requirements: Scholarship Requests are accepted until April 25, 2022. Requests submitted after April 25 will not be reviewed. The entire Surge Camp application must be completed. Scholarship recipients must pay $25 toward their camp fees.

Notice of Award: All scholarship requestees will be notified VIA EMAIL as to whether they are the recipient of the scholarship or not by May 5, 2022. **Please make sure the email address you provide is checked often** Scholarship recipients have until May 12, 2022 to submit the $25 fee. If the fee is not received by May 12 at 2:30 p.m., the scholarship will go to another requestee, without notice.

Are you requesting a full or partial scholarship?^*

Full Scholarship
Partial Scholarship

Please provide the amount you are willing and able to pay (Please enter a number, a PayPal Invoice will be sent to you via email)

Please explain why a scholarship is being requested:^*

I acknowledge that if my camper receives the scholarship, I will be liable and am prepared to pay the $25 camp fee by May 12, 2022, at 2:30 p.m..^*

Medical Information

Please list any allergies/medications or other medical conditions that would prevent camper from participating in all activities

Name of Insurance Company Covering Camper^*

Policy Number:

Name of Policy Holder:

Emergency Contact Name^*

Emergency Contact Phone Number^*

Church Information

Church You Attend^*

Member of Church?^*

Youth Leaders Name

Roommates

Please list your 1st and 2nd choices for a roommate (We will do our best to give you one of these, but keep in mind that if the person you choose has listed other people, it may be difficult to accommodate everyone. Communication with your chosen roommate would help insure your choice).

Roommate First Choice

Roommate Second Choice

Terms & Conditions

By Checking & Typing your name below you agree: As a camper I agree to abide by all the rules set forth by the DBA Youth Camp Leadership Team. I further understand that failure on my part to comply with rules and directions given by the event organizers and youth leaders that are serving as counselors and chaperones of the event will merit my immediate dismissal from the DBA Youth Camp at my parent/guardian’s expense.

Camper Check^*

I Agree

Camper Signature^*

Date^*

By Checking & Typing your name below you agree: As a parent/guardian I agree to allow my child to attend the 2022 DBA Youth Camp. I understand that the event organizers, the DBA, individual DBA churches or BPC will not be held liable for injuries incurred as a result of my child’s attendance at this event. Should injury or illness arise, other than minor injury, I give my permission for medical care to be provided. I shall be fully responsible for payment of such cost. I also give my permission for any photographs taken of my child to be used for possible promotion of camp. I also give my permission for my child to be transported from Brewton-Parker while participating in local mission projects.

Parent/Guardian Check^*

I Agree

Parent/Guardian Signature^*

Date^*

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