Scholarships – Youth Camp/Retreats – Northern Lights Region

Please fill out all required(*) fields and submit.
If printing, click here, then scan and email to office@northernlightsdisciples.org or mail to
Northern Lights Region, 4227 S Meridian, C615, Puyallup, WA 98373.

* denotes a required field.

Camper's Name *

First

Last

Parent/Guardian's Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Parent/Guardian's Email Address *

Parent/Guardian's Phone Number *

Associated church (if applicable), or, what/who is your connection to this camp or retreat? *

Minister's name (if associated with a church)

Has your camper previously attended a youth camp or retreat in the Northern Lights Region? *

Yes
No

If yes, which camp or retreat? When?

Have you been in contact with a local congregation for scholarship support? *

Yes
No

If yes, is that church providing partial support? How much?

Regional scholarship amount requested: *

Full
Half
Other

If Other, please explain:

Is there anything else you would like us to know that would help in considering this request?

By submitting my name, I confirm my request for a scholarship for this camper. *

Parent/Guardian's signature