EmailMe Form - Children Support Fund Application V1.2

About the Children's Support fund

Application to the Children’s Support Fund:
 Applications for funding assistance close two weeks before the commencement of each camp.
 All applicants will be notified to the person applying for assistance on this form. Applications are subject to availability at the Camp.
 Please be aware that subsidy funds come from donations we receive from friends of Camp Clayton, and at times resources for this fund may be limited.
 We expect to give partial assistance to a number of applicants and all applications will be given good consideration.
 Subsidies will generally not be given for the full cost of a camp, and applicants are encouraged to contribute as much as is reasonably possible of the cost.
 Decisions for special needs assistance are final and will not be entered into. Assessments are not carried out by Camp Clayton Staff.
 All applications for assistance are kept confidential.

Further Enquiries: Enquiries about the Children’s Support Fund should be directed to the Executive Officer. Phone: 6425 1893 or Email on admin@campclayton.org.au

Name of Child *

First Last

DOB of Child *

DD / MM / YYYY

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Which camp are you seeking assistance for ? *

Person applying for assistance *

Relationship to Camper *

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

IF DIFFERENT TO ABOVE ADDRESS

Phone 1 *

Email *

Explanation / Comments *

Short explanation why support is sought for camper.

Income

What is the approximate monthly income of the camper’s family and the source of that income? (Include Centrelink benefits)

Income

Amount per month

$ Dollars

Income

Amount per month

$ Dollars

Income

Amount per month

$ Dollars

Income

Amount per month

$ Dollars

Financial Obligations

What family obligations are met through this (ie. rent/mortgage, regular payments etc)

Obligations

Please list financial obligations and the approximate monthly amount.

Number of dependent children

Referee

Applications must be supported by a referee from a recognised welfare organisation or local church (for example, Temcare, Salvation Army, Anglicare, youth pastor or church minister). It may be necessary for us to disclose information you submit in this application to that person, in confidentiality with them.

Name

First Last

Positon Held

Organizaton

Phone contact

Supplementary

Commitment *

$ Dollars

If you are successful in receiving some assistance, how much of the camp fee would you be able to contribute? (Assistance is not given for the full fee)

Payment plan

If you are unsuccessful in receiving assistance, would a payment plan help in paying the camp fees? If so, please state the terms that would be acceptable to you. (Eg. Payment of $25 per month for three months).

Thank you for completing the application, somebody will get back to you soon.

Further Enquiries: Enquiries about the Children’s Support Fund should be directed to the Site Manager. Phone: 6425 1893 or Email on admin@campclayton.org.au