CUB WORLD TEN MILE RIVER SPECIALTY CAMPS
Greater New York Councils Boy Scouts of America
2015 Campership Application (due by May 31st)
Dear Parent/Scout Leader: • Greater New York Councils offers camperships to registered youth from New York City to assist with camp fees. Campership amounts are based on amount requested and family need. In some cases, depending on specific circumstances, no campership may be awarded. • This form must be completely filled out. Incomplete forms will be rejected without consideration. • Total yearly income must reflect all household family members. On the other side of this form, include all types of household income: salary, unemployment insurance, pensions, alimony, disability, public assistance, earned income tax credit, etc. • A $25 per camper, per session/week deposit must be paid for this application to be considered. Campership requests without deposits will be rejected. DO NOT SEND APPLICATION WITHOUT PAYMENT. The campership amount you are requesting must be specified. • To accurately credit the unit with the camper’s awarded amount, the council, district, and pack/troop information must be completed. • Cub Scouts who are crossing over to Boy Scouts must indicate their new troop and the troop they will be attending camp with. Submit camper’s transfer information to the GNYC office on time to avoid confusion in locating camper with the appropriate unit. • Camperships awarded will be based on the Early Bird cost. No consideration will be given for the higher fee charged after May 31st. • Any awarded campership amount is included and deducted from the total camp cost of fees due by May 31st. All campers who have not received camperships by May 31st will be responsible for full payment. Reimbursement, if any will be provided in a pack/troop check while unit is at camp (if no discrepancies are found). We do not make checks out to individuals (except for youth attending an individual specialty camp). Please keep track of payments by individual parents for their reimbursement from the pack/troop check. See reverse side for additional required information Note: For this application to be considered you must provide a receipt number or enclose a $25 per week deposit with this application. If you have already paid the $25 per session/week deposit ❏ Is it an individual payment?
What is the receipt number?
❏ Is it included with a unit payment? Who was payment given to? If you haven’t already paid the $25 per session/week deposit, select the payment method ❏ Cash
❏ Check or Money Order # Cardholder Information
Name * Signature
(Payable to: GNYC, BSA)
❏ Credit Card – complete the following:
Type of Card Card Number Expiration Date
I agree to pay the amount above according to the card issuer agreement
/ * Print name as written on card
Check Whichever Apply: Our unit participated in these GNYC activities from 6/1/14 to 5/31/15: ❏ Friends of Scouting ❏ Parade ❏ Popcorn ❏ Camp Cards
Our unit scheduled and held the following presentations: ❏ Camp Presentation ❏ Open House for New Members
Customer Service: If you have any questions, please contact Camping Services at 212.651.3073 or at [email protected]. Forms can be downloaded at www.bsa-gnyc.org/campforms or requested from Camping Services. Thank you for camping at a Greater New York Councils camp. Providing you with an extraordinary outdoor adventure is our goal!
Parents: For your son(s)’s campership application(s) to be accepted by Greater New York Councils you must to fill out all camper information, parent information, and family income on the next page. Unit leaders must collect applications and a non-refundable deposit of $25 per camper, per week/session for each application submitted. This eliminates incomplete applications, payment confusion and delays. Applications are handled by units, not individuals (except for youth attending an individual specialty camp). Send Completed Forms To: Greater New York Councils (GNYC), Boy Scouts of America; 350 Fifth Avenue, Suite 7820; New York, NY 10118 or fax to 212.651.2445. GNYC only grants camperships to GNYC registered youth who attend GNYC camps. Note: Scouts requesting campership money must submit one handwritten thank you postcard (complete with their name, borough/ council and pack/troop number) for every $25 requested to their Cubmaster or Scoutmaster. Unit leaders can pick up blank postcards from the GNYC office or from their District Executive and should submit completed ones with this application. For Camping Services Use Only Date Rec’d:______________ Receipt #: ______________ Amount Paid: ____________ Entered by: _____________ Campership amount approved ___________ Date submitted to GNYC office with payment:
*1670170221* 1-6701-702-21 - Cub World
(unless deposit was already paid)
*1670170121* 1-6701-701-21 - TMR
Campership App.fm - Jan. ’15
Please write clearly!
LEADER, UNIT AND CAMP ATTENDANCE INFORMATION Leader’s Name
Contact #
Unit Type
Unit #
Borough ❏ Bronx District
Email
Camp Unit (if different from Home Unit) #
❏ Brooklyn
❏ Manhattan ❏ Queens
❏ Staten Island
❏ Bronx River ❏ Breukelen ❏ Lenape Bay ❏ Big Apple ❏ Founders ❏ Pathfinder ❏ Tomahawk ❏ Aquehonga
Dates and Rates of Summer Camp CUB WORLD ❏ Cub World - $210/session * ❏ Cub World - $370/week * Session / Dates
TEN MILE RIVER ❏ Ten Mile River - $375/week * ❏ TMR Provisional Troop - $375/week * Week / Dates Camp
SPECIALTY CAMPS AT TEN MILE RIVER ❏ Ten Mile River Trek - $390/week * ❏ Ten Mile River Specialty Camp - $390/week * Specialty Camp (Camp & Weeks)
❏ 1A / June 28-July 1
❏ 0 / June 28-July 4
❏ Aquehonga
❏ TMR Provisional Trek (Keowa Wks 1,2,3,4,5)
❏ 1B / July 1-4
❏ 1 / July 5-11
❏ Keowa
❏ Natl. Youth Leadership Training (Keowa Wk 1)
❏ 2A / July 5-8
❏ 2 / July 12-18
❏ Ranachqua
❏ Film & TV Production Camp (Keowa Wk 2)
❏ 2B / July 8-11
❏ 3 / July 19-25
❏ Eagle Camp (Keowa Wk 3)
❏ 3A / July 12-15
❏ 4 / July 26-Aug. 1
❏ Aviation Camp (Keowa Wk 4)
❏ 3B / July 15-18
❏ 5 / Aug. 2-8
❏ Eagle Camp (Ranachqua Wk 5)
❏ 4A / July 19-22
❏ 6 / Aug. 9-15
❏ Shooting Sports Camp (Keowa Wk 5)
❏ 4B / July 22-25
❏ Aquatics Camp (Keowa Wk 6)
❏ 5A / July 26-29
❏ Eagle Camp (Aquehonga Wk 6)
❏ 5B / July 29-Aug. 1 ❏ TMR Provisional Trek (Aquehonga Wk 6) * Early bird fee through May 31st. Higher by $30/week or $15/session after May 31st. Camperships are based on the Early Bird fee. CAMPER INFORMATION First Name
Last Name
Address
Apt.
School Attending
Date of Birth City
State
Grade
ZIP
Scout Rank
PARENT/GUARDIAN INFORMATION First Name
Last Name
Address Day Phone
Apt.
State
Evening Phone
Alternate Contact First Name Day Phone
City
ZIP
Email Address Last Name
Evening Phone
Email Address
FAMILY INCOME: Total yearly income must reflect all types of income: salary, unemployment, pensions, alimony, EITC, etc. for all family members. Financial need (reasons) must be specified. Your application will be denied if the need is not explained. Total Yearly Income for Household (Gross / Pre-tax): Number of Family Members Residing at Home:
Adults
* Campership Amount Requested Children
# of children attending Scout camp
Detailed Reasons that Campership Assistance is Needed
* Each Scout requesting campership money must submit one completed postcard for every $25 requested. Unit leaders can pick up blank postcards from the council office or from their District Executive and should submit completed ones with this application. SIGNATURES: I certify that the information that I supplied in this application is accurate.
Parent/Guardian
Unit Leader
2015 Campership Application (due by May 31st)
Dear Parent/Scout Leader: • Greater New York Councils offers camperships to registered youth from New York City to assist with camp fees. Campership amounts are based on amount requested and family need. In some cases, depending on specific circumstances, no campership may be awarded. • This form must be completely filled out. Incomplete forms will be rejected without consideration. • Total yearly income must reflect all household family members. On the other side of this form, include all types of household income: salary, unemployment insurance, pensions, alimony, disability, public assistance, earned income tax credit, etc. • A $25 per camper, per session/week deposit must be paid for this application to be considered. Campership requests without deposits will be rejected. DO NOT SEND APPLICATION WITHOUT PAYMENT. The campership amount you are requesting must be specified. • To accurately credit the unit with the camper’s awarded amount, the council, district, and pack/troop information must be completed. • Cub Scouts who are crossing over to Boy Scouts must indicate their new troop and the troop they will be attending camp with. Submit camper’s transfer information to the GNYC office on time to avoid confusion in locating camper with the appropriate unit. • Camperships awarded will be based on the Early Bird cost. No consideration will be given for the higher fee charged after May 31st. • Any awarded campership amount is included and deducted from the total camp cost of fees due by May 31st. All campers who have not received camperships by May 31st will be responsible for full payment. Reimbursement, if any will be provided in a pack/troop check while unit is at camp (if no discrepancies are found). We do not make checks out to individuals (except for youth attending an individual specialty camp). Please keep track of payments by individual parents for their reimbursement from the pack/troop check. See reverse side for additional required information Note: For this application to be considered you must provide a receipt number or enclose a $25 per week deposit with this application. If you have already paid the $25 per session/week deposit ❏ Is it an individual payment?
What is the receipt number?
❏ Is it included with a unit payment? Who was payment given to? If you haven’t already paid the $25 per session/week deposit, select the payment method ❏ Cash
❏ Check or Money Order # Cardholder Information
Name * Signature
(Payable to: GNYC, BSA)
❏ Credit Card – complete the following:
Type of Card Card Number Expiration Date
I agree to pay the amount above according to the card issuer agreement
/ * Print name as written on card
Check Whichever Apply: Our unit participated in these GNYC activities from 6/1/14 to 5/31/15: ❏ Friends of Scouting ❏ Parade ❏ Popcorn ❏ Camp Cards
Our unit scheduled and held the following presentations: ❏ Camp Presentation ❏ Open House for New Members
Customer Service: If you have any questions, please contact Camping Services at 212.651.3073 or at [email protected]. Forms can be downloaded at www.bsa-gnyc.org/campforms or requested from Camping Services. Thank you for camping at a Greater New York Councils camp. Providing you with an extraordinary outdoor adventure is our goal!
Parents: For your son(s)’s campership application(s) to be accepted by Greater New York Councils you must to fill out all camper information, parent information, and family income on the next page. Unit leaders must collect applications and a non-refundable deposit of $25 per camper, per week/session for each application submitted. This eliminates incomplete applications, payment confusion and delays. Applications are handled by units, not individuals (except for youth attending an individual specialty camp). Send Completed Forms To: Greater New York Councils (GNYC), Boy Scouts of America; 350 Fifth Avenue, Suite 7820; New York, NY 10118 or fax to 212.651.2445. GNYC only grants camperships to GNYC registered youth who attend GNYC camps. Note: Scouts requesting campership money must submit one handwritten thank you postcard (complete with their name, borough/ council and pack/troop number) for every $25 requested to their Cubmaster or Scoutmaster. Unit leaders can pick up blank postcards from the GNYC office or from their District Executive and should submit completed ones with this application. For Camping Services Use Only Date Rec’d:______________ Receipt #: ______________ Amount Paid: ____________ Entered by: _____________ Campership amount approved ___________ Date submitted to GNYC office with payment:
*1670170221* 1-6701-702-21 - Cub World
(unless deposit was already paid)
*1670170121* 1-6701-701-21 - TMR
Campership App.fm - Jan. ’15
Please write clearly!
LEADER, UNIT AND CAMP ATTENDANCE INFORMATION Leader’s Name
Contact #
Unit Type
Unit #
Borough ❏ Bronx District
Camp Unit (if different from Home Unit) #
❏ Brooklyn
❏ Manhattan ❏ Queens
❏ Staten Island
❏ Bronx River ❏ Breukelen ❏ Lenape Bay ❏ Big Apple ❏ Founders ❏ Pathfinder ❏ Tomahawk ❏ Aquehonga
Dates and Rates of Summer Camp CUB WORLD ❏ Cub World - $210/session * ❏ Cub World - $370/week * Session / Dates
TEN MILE RIVER ❏ Ten Mile River - $375/week * ❏ TMR Provisional Troop - $375/week * Week / Dates Camp
SPECIALTY CAMPS AT TEN MILE RIVER ❏ Ten Mile River Trek - $390/week * ❏ Ten Mile River Specialty Camp - $390/week * Specialty Camp (Camp & Weeks)
❏ 1A / June 28-July 1
❏ 0 / June 28-July 4
❏ Aquehonga
❏ TMR Provisional Trek (Keowa Wks 1,2,3,4,5)
❏ 1B / July 1-4
❏ 1 / July 5-11
❏ Keowa
❏ Natl. Youth Leadership Training (Keowa Wk 1)
❏ 2A / July 5-8
❏ 2 / July 12-18
❏ Ranachqua
❏ Film & TV Production Camp (Keowa Wk 2)
❏ 2B / July 8-11
❏ 3 / July 19-25
❏ Eagle Camp (Keowa Wk 3)
❏ 3A / July 12-15
❏ 4 / July 26-Aug. 1
❏ Aviation Camp (Keowa Wk 4)
❏ 3B / July 15-18
❏ 5 / Aug. 2-8
❏ Eagle Camp (Ranachqua Wk 5)
❏ 4A / July 19-22
❏ 6 / Aug. 9-15
❏ Shooting Sports Camp (Keowa Wk 5)
❏ 4B / July 22-25
❏ Aquatics Camp (Keowa Wk 6)
❏ 5A / July 26-29
❏ Eagle Camp (Aquehonga Wk 6)
❏ 5B / July 29-Aug. 1 ❏ TMR Provisional Trek (Aquehonga Wk 6) * Early bird fee through May 31st. Higher by $30/week or $15/session after May 31st. Camperships are based on the Early Bird fee. CAMPER INFORMATION First Name
Last Name
Address
Apt.
School Attending
Date of Birth City
State
Grade
ZIP
Scout Rank
PARENT/GUARDIAN INFORMATION First Name
Last Name
Address Day Phone
Apt.
State
Evening Phone
Alternate Contact First Name Day Phone
City
ZIP
Email Address Last Name
Evening Phone
Email Address
FAMILY INCOME: Total yearly income must reflect all types of income: salary, unemployment, pensions, alimony, EITC, etc. for all family members. Financial need (reasons) must be specified. Your application will be denied if the need is not explained. Total Yearly Income for Household (Gross / Pre-tax): Number of Family Members Residing at Home:
Adults
* Campership Amount Requested Children
# of children attending Scout camp
Detailed Reasons that Campership Assistance is Needed
* Each Scout requesting campership money must submit one completed postcard for every $25 requested. Unit leaders can pick up blank postcards from the council office or from their District Executive and should submit completed ones with this application. SIGNATURES: I certify that the information that I supplied in this application is accurate.
Parent/Guardian
Unit Leader
