Please note, campership awards are not guaranteed for applicants.

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1 Please mail all correspondence to: Camp Fire Minnesota Attn: Campership 4829 Minnetonka Blvd. Suite 202 St. Louis Park, MN Camp Fire Minnesota is committed to making camp accessible to as many youth as possible. Our camp scholarships (camperships) provide assistance to families for whom payment of the full tuition is not possible. Camperships are awarded based on financial need and funds available. Please note, campership awards are not guaranteed for applicants. Campers may initially request a campership to attend one session (one week) at Tanadoona or Bluewater. Parents/guardians with more than one camper may apply for one campership per camper. Determining Financial Need: Camp Fire MN knows that many factors beyond income affect a family s finances. We consider all information presented in this application when evaluating campership requests. The 2015 Poverty Guidelines below are a reference point for determining financial assistance. If you do not fit within the below guidelines, but have financial hardship from medical bills, housing, etc. please give those details in the Circumstances section of the application on page 3. What we need from you: This application completed in full Poverty Guidelines for the 48 Contiguous Sates Persons in Poverty Guideline Family/Household 1 $11,770 2 $15,930 3 $20,090 4 $24,250 5 $28,410 6 $32,570 7 $36,570 8 $40,890 For families/households with more than 8 persons, add $4,160 for each additional person. o ONE campership form per family (page 3), plus ONE registration form PER camper (pages 4 and 5) is required. Example: If you are applying for three campers, list all three campers on page 3. Then complete the registration form on pages 4 and 5 for each of your campers. A $50 deposit fee per camper. We ask that all families contribute at least the $50 deposit fee per camper per session. We accept checks and credit cards. If you want to pay by credit card, please note that on the application and we will contact you for the card number. You may also put the card number on the payment section of the registration form. What we don t need from you: We do not require personal information such as copies of free lunch eligibility, tax records, etc. 1

2 How does the campership application work? 1) Fill out all necessary forms and submit them to the Camp Fire MN office as early as possible. Forms may be sent to our mailing address 4829 Minnetonka Blvd Suite 202, St. Louis Park, MN We also accept forms via at or by fax to The sooner you submit these forms, the more likely we can award you a scholarship! 2) Be patient! We do not begin processing campership applications until February and award them on a monthly basis. Beginning in May, we award camperships as they arrive at the office. 3) You receive notice on your campership award! Get ready for summer fun at Tanadoona. If you are granted a campership you will receive an Award Letter with the dollar amount of the scholarship you receive. At the end of summer, we will send a packet to your house that contains several blank thank you cards and a pre-paid envelope to mail those cards back to us. Thank you cards: These cards must be filled out by the camper(s) or family and mailed back to our office. Failure to return these to the office might affect any future applications you submit for campership funding. Why do we ask for Thank Yous? Our generous donors have asked that we provide feedback from families who receive financial assistance in the form of thank you cards. We encourage you and your camper(s) to be creative and include your favorite aspects of camp with words and drawings if you like! Feel free to use markers, crayons, or colored pencils to make these Thank Yous extra special. FAQs What if I want to apply for several weeks of camp? Please submit only your preferred week of camp on your application. We want to be able to help as many campers as possible! After we have granted camperships to a majority of our families, we will accept second round campership applications for additional weeks. Can I submit two applications at the same time for the same child? If you would like to send in two campership requests for the same camper, please fill out two of these forms. At the top of each form please write First Choice and Second Choice accordingly. We will save your second choice application for later in the spring. If funds are still available, we will begin awarding second weeks to families who have applied. I received a campership last year. Do I automatically get one this year? No. Camperships are awarded based on financial need in addition to first come, first serve. While we try to give support to all families, we ask that you send your application as soon as possible to make sure it is reviewed while funds are available. My financial circumstances do not fit inside federal poverty guidelines. Can I still apply? Absolutely! We use many different ways to evaluate who qualifies for a campership. If you are paying more for medical bills, housing, or have another situation with financial hardship, let us know in the Circumstances section of the application on page 3. I do not need to have my camper s entire session fee covered. Can I apply for a partial scholarship? Yes and in fact we encourage that. Many families contribute as much as they can to their camper s session fees. We can then help with the remaining portion that they can t quite cover. 2

3 Camp Scholarship (Campership) 2016 Registration Form Camper s Name: DAY CAMPS Wk Date Session Age Cost 1 June 6-10 Tanadoona Day Camp 5-14 $235 2 June Tanadoona Day Camp 5-14 $235 Tanadoona Outback 6-7 $255 Skyhigh Adventure 8-10 $255 Bullseye Club Archery $255 3 June Tanadoona Day Camp 5-14 $235 Bullseye Club Archery 8-10 $255 Castaway Canoe Camp 8-10 $255 Skyhigh Adventure $255 4 June 27 Tanadoona Day Camp 5-14 $235 -July 1 A Pirate s Life 6-7 $255 Sports Galore 8-10 $255 Castaway Canoe Camp $255 5 July 6-8 Tanadoona Day Camp 5-14 $150 6 July Tanadoona Day Camp 5-14 $235 Skyhigh Adventure 8-10 $255 Tanadoona Outback 8-10 $255 Bullseye Club Archery $255 7 July Tanadoona Day Camp 5-14 $235 Bullseye Club Archery 8-10 $255 Skyhigh Adventure $255 Tanadoona Outback $255 8 July Tanadoona Day Camp 5-14 $235 Minnewashta Minnows 6-7 $255 Adventures in Art 8-10 $255 9 Aug 1-5 Tanadoona Day Camp 5-14 $235 Skyhigh Adventure 8-10 $255 Bullseye Club Archery $255 Sports Galore $ Aug 8-12 Tanadoona Day Camp 5-14 $235 Tanadoona Outback 6-7 $255 Sports Galore 8-10 $255 Castaway Canoe Camp $ Aug Tanadoona Day Camp 5-14 $235 Bullseye Club Archery 8-10 $255 Skyhigh Adventure $ Aug Tanadoona Day Camp 5-14 $150 DAY CAMP EXTRAS Extras: Session #(s)* Cost/wk Total Cost: $30/wk ($18 wks 5 & 12) Before and After $40/wk ($24 wks 5 & 12) Thursday Overnight (not available wk $45/wk Lunch + Overnight (not available wk $70/wk Total *Please list the session number(s) your child is attending. Example: Lunch: Sessions 1, 5, 7; total Extras cost: $78 OVERNIGHT CAMPS Wk Date Session Age Cost 2 June Resident Camp 7-16 $450 June Mini-Resident Camp 7-14 $290 3 June Resident Camp 7-16 $450 4 June 26-July1 Resident Camp 7-16 $450 June Mini Resident Camp 7-14 $290 5 July 5-8 Resident Camp 7-16 $290 6 July Resident Camp 7-16 $450 July Mini Resident Camp 7-14 $290 July Northwoods Adventure $500 7 July Resident Camp: Teen Week $450 8 July Resident Camp 7-16 $450 July Mini Resident Camp 7-14 $290 9 July 31-Aug 5 Resident Camp 7-16 $450 July 31-Aug 5 Northwoods Adventure $ Aug 7-12 Resident Camp 7-16 $450 Aug 7-10 Mini-Resident Camp 7-14 $ Aug Resident Camp 7-16 $450 Aug Northwoods Adventure $500 LEADERSHIP DEVELOPMENT Wk Date Session Age Cost 8 July Day Camp Assistant (DCA) $ August 7-12 Counselor in Training August (CIT) $525 TOTAL AMOUNT: Session Fee(s) $ + Day Camp Extras (optional) $ + Store Account (optional) $ + Campership Fund Donation $ - Early Bird Discount (when tution paid in full by 3/15/16) $ = GRAND TOTAL $ updated 4/15/2016 4

4 *Please fill out one form per family. This must be filled out in addition to the Camp Registration form on pages 4 and Campership Application Parent/Guardian Name: County of Residence: Address: City/State: Zip code: Home Phone: Work Phone: Number of persons living in household: 2015 annual household income* before taxes: $ *Include all sources: AFDC, Alimony, Unemployment Insurance, Workers Compensation, Insurance settlements, Dividends and/or Interest, Employment Wages full and/or part-time, and any other income. Name(s) of camper(s) seeking scholarship: Age: Camp Session: Age: Camp Session: Age: Camp Session: (Optional) Are there any special circumstances affecting your family that you would like us to consider when reviewing your application? Calculating your Campership Request Total camp fees due for 2016 registration: $ Total amount of any deposits enclosed*: - $ *$50 deposit is required by all families per session and camper. Additional amount your family can pay toward - $ remaining camp fees: Total Amount of Campership Requested: $ Submit your application any of the following ways: Mail: Camp Fire Minnesota, Attn: Campership, 4829 Minnetonka Blvd, Suite 202, St. Louis Park, MN info@campfiremn.org, subject line campership application Fax: (952) , Attn: Campership 3

5 Camper Information First Name: Nickname (if preferred): Last Name: Birth date: / / 18 5 Gender: M Age: Grade (Fall 16): School: F Camper Lives with: Both Parents One Parent Two Households Other, please specify: 2016 is this camper s year at Tanadoona We prefer communication by: Mail ONE Cabin Mate/Buddy s Name: (read cabin mate/buddy policy on pg. 19 of brochure) Cabin Mate/Buddy s Age: Primary Parent/Guardian Information (where child resides) First Name: Last Name: Home Phone: Address: City: State: Zip: County: Cell Phone: Relationship to Camper: Secondary Parent/Guardian Information (if applicable) First Name: Last Name: Home Phone (if different than above): Address (if different than above): Cell Phone: City: State: Zip: Other Phone: Relationship to Camper: Additional Emergency Adult Contact (in case the adult(s) listed above cannot be reached) First Name: Last Name: Phone: Please list any additional persons, not listed above, who are authorized to pick up your child. We release your child only to those listed here & above. Include everyone in your carpool (please attach a sheet if you need more space). First Name: Last Name: Phone: First Name: Last Name: Phone: How did you hear about Camp Tanadoona? (please check all that apply) [ ] Attended previous years [ ] Heard from a friend/family member [ ] Involved in Camp Fire Club program [ ] Received a brochure in the mail [ ] Saw a school flyer [ ] Camp Fire Minnesota website or E-News [ ] Saw an online ad/listing [ ] Saw an ad/notice in my local newspaper [ ] Parent/Guardian is Camp Fire Alumni [ ] Other: Demographic Information (This information is optional and will remain confidential) Which population group(s) do consider yourself a part of: [ ] African [ ] Asian [ ] Hispanic/Latino [ ] Native American [ ] African-American [ ] Caucasian [ ] Multiracial [ ] Other [ ] Our family qualifies for free lunch [ ] Child has Individualized Education Program (IEP) [ ] Our family qualifies for reduced price lunch All registrations must include a $50 per session deposit, which will be applied toward the camper s registration fees. Full payment must then be received by April 30, All registrations received after April 30 must include full payment. Camp Tanadoona qualifies as a child care option for tax purposes. Camp Fire Minnesota's federal tax ID number is See page 19 for more details. [ ] Check enclosed for $ Make checks to Camp Fire Minnesota (if not paid in full, invoice will be mailed) [ ] Charge my credit card this amount now $ If not the full amount, please indicate preferred option below: [ ] Automatically charge my card the remaining balance on March 15, 2016 and get the Early Bird Discount [ ] Automatically charge my card the remaining balance on April 30, 2016 [ ] Send me an invoice for the remaining balance [ ] Send me information about Camperships Name (as it appears on card) Card Number (we accept VISA, Mastercard, and Discover) / Exp. Date Security Code Cardholder s Signature Participation Agreement I wish to register my child for Camp Fire Minnesota's camp program. I understand that children will spend time practicing activities under the supervision of trained instructors. I have read and agree to the policies and program descriptions listed in this brochure for this year s camp program season. I recognize that participation in recreation and instruction activities, even when well supervised and managed, poses a risk to my child, and I agree to assume such risk on behalf of my child. In the case of injury, I authorize Camp Fire Minnesota staff to administer first aid and/or obtain medical treatment they deem necessary for the welfare of my child. I further agree that I will be financially responsible for all charges and fees incurred in the rendering of said treatment, regardless of whether my medical insurance would cover such charges and fees. I, the undersigned, hereby hold Camp Fire Minnesota, its employees and agents harmless from liability for any and all medical and/or accident expenses that my minor child may incur during their involvement in Camp Fire programs. I understand that Camp Fire Minnesota reserves the right to dismiss children due to inappropriate behavior that could lead to the physical or emotional harm of themselves and/or others. I also understand that Camp Fire Minnesota reserves the right to remove children whose behavior contributes to the continued disruption of activities. I understand that Camp Fire Minnesota will take video & voice recordings and photographs of my child s participation in Camp Fire programs and use these images on Camp Fire's website, social network sites (like Flickr and Facebook) and in publications unless I contact the Camp Fire main office to instruct them otherwise. I have read and understand the above, and I agree to the terms and conditions of this registration. Parent/Guardian Signature Date

6 Information and Policies 2016 Camp Store Policies All campers have the opportunity to purchase snacks and merchandise from the camp store. Families may deposit money into their camper s store account during online registration, on the first day of camp, or by calling Camp Fire s Administrative Office at Families will be notified of any balance remaining in their child s camp store account at the end of the camp season (September 2016). Families may choose to donate their remaining balance to the Camp Fire Campership Fund or have the balance refunded. Balances at or below $7.50 will be automatically donated to the Camp Scholarship Fund. Refunds are subject to a $2.50 administrative fee. Activity Limitations For safety reasons, campers under the age of 8 cannot fully participate in archery activities and are not allowed to participate in climbing activities. Some camp activities are subject to cancellation due to weather conditions at the discretion of the Camp Director. All campers must take a swim test on the first day of camp to determine if they are required to swim with a life vest. Visit camptanadoona.org/parents for swim test details. Cabin Mate Requests for Overnight Camp Overnight campers may request one friend of the same age and gender as a cabin mate. Requests will only be considered if both campers request each other; one-way requests will not be granted. Camp Tanadoona has final say on all placements and cannot guarantee cabin mate requests can be met. Tanadoona staff cannot give out information regarding existing cabin mate requests. Tanadoona s cabin mate policies are in place to provide social comfort and help prevent bullying. Thank you for helping us create a welcoming environment for all campers! Buddy Requests for Day Camp Day Campers may request one friend to be paired with at camp. This camper must be close to the same age and registered for the same camp session. Due to liability restrictions for our Archery and High Ropes Adventure Course, seven and eight year olds cannot be paired together. Requests will only be considered if both campers request each other; one-way requests and linked requests between multiple campers (daisy-chained) will not be granted. Camp Tanadoona has final say on all placements and cannot guarantee that buddy requests can be met. Tanadoona staff cannot give out information regarding buddy requests if the camper in question is not registered under the inquiring family s account. Tanadoona s buddy policies are in place to provide social comfort and help prevent bullying. Thank you for helping us create a welcoming environment for our campers! Payment Information A $50 per session deposit is required on camp registrations; this will be applied toward the camper s registration fees. To receive the Early Bird Discount full payment must be received by March 15. Full payment for all camp sessions must be received by April 30. Any registrations received after April 30 must include full payment. Failure to meet payment due date may cancel your registration and advance another camper from the waiting list. Payment arrangements can be made by contacting Camp Fire s Administrative Office at Cancellation and Refund Policies All cancellations must be received in writing by ing info@campfiremn.org. If you cancel 30 days before the session begins, Camp Fire will refund the session fees, but retain the $50 deposit for each session. No refunds will be issued for cancellations of sessions with less than 30 days prior notice. Transfers to another session less than two weeks prior to the session start date will be subject to a $50 transfer fee. No refunds will be given if your child leaves camp early or arrives late for any reason. Camp Fire reserves the right to cancel any program for any reason we deem necessary. We will give as much notice as possible, and if we cannot find another acceptable Camp Fire camp session, you will receive a full refund. Applying for Financial Assistance Camperships Camp Fire Minnesota provides scholarships (camperships) for camp to families who have a financial need. We ask families to apply early and contribute as much as possible to their child s camp fees. Applications for camperships are available at camptanadoona.org/scholarship or by calling Accessibility Statement Camp Fire is an inclusive organization open to every person in the communities we serve. We welcome children, youth and adults regardless of race, religion, socio-economic status, disability, sexual orientation or other aspects of diversity. We will work to accommodate any special needs to the extent that our financial and physical resources permit. Please let us know if we can work with you in this manner by calling Child Care Reimbursement Camp Tanadoona qualifies as a child care option for tax purposes. Camp Fire Minnesota s federal tax ID number is Payment arrangements for flexible spending or other reasons are made on a case-by-case basis. Please contact Camp Fire s office at to discuss or receive documentation of attendance. Camp Fire Minnesota (Tanadoona s Administrative Office) 4829 Minnetonka Blvd., Ste. 202, St. Louis Park, MN campfiremn.org 19 6