Hopkinton Recreation Department
Camp Scholarship Application Form
Full and partial scholarships are available for children attending summer camp at the Hopkinton Summer Day Camp. A few rules apply:
1. Recipient must be a resident of Hopkinton/Contoocook.
2. This scholarship application must be received with the camp application and payment due. Only regular camp tuition is eligible for scholarship. Registration fees and extended care fees are not eligible and will be the applicant’s responsibility.
3. You must provide household income verification with this application (current 1040 tax form or past 2 pay stubs).
4. All other camp application materials must be correct and complete.
5. Each child may receive scholarship for up to one full week camp session; any additional weeks may be eligible for partial scholarship (depending upon remaining scholarship funds available).
6. Scholarship requests are confidential and the Hopkinton Recreation Department will use the information on the application only to decide if your child(ren) qualify to receive a full or partial scholarship to the summer camp programs.
7. You will be notified by mail when a decision has been reached regarding your scholarship request as soon as possible.
1. Submit a completed application to the Hopkinton Recreation Department, 330 Main Street, Hopkinton, NH 03229 by Friday, June 14, 2013. Late applications will not be reviewed.
2. Only requests accompanied by current income verification will be reviewed.
3. A scholarship will be awarded only after the family’s finances have been reviewed, together with any extenuating circumstances, and a camp registration has been verified. This is a need-based scholarship fund.
4. Applications without all necessary information will not be reviewed and you will not be notified. Please make sure that all information is filled out completely and all accompanying documents are mailed with this form.
Hopkinton Recreation Department Camp Scholarship Application Form
Name of Child _____________________________________________
Name of Parent/Guardian_____________________________________
Home Address ____________________________________________
Phone (day) _____________________ (evening) __________________
Session #(s): _____________________________________________
Number of people in your household________________
Household gross income in 2012 $_____________
Any factors you would like us to consider (attach additional sheet(s) if necessary):
I agree that I have read the scholarship conditions. To the best of my knowledge the above information is correct. I agree that if I am found to have falsified information on this form, I will be held responsible for all camp costs that my child incurs while participating in the Hopkinton Recreation Department programs. Further, I agree to release and discharge the Hopkinton Recreation Department, Town of Hopkinton and its officers, directors, employees, and agents of and from any claims, demands, or liability of damage arising from the participation of my child in any program sponsored by the Hopkinton Recreation Department.
Parent/Guardian’s Signature________________________ Date _______