Angel Tree Scholarship Form

Angel Tree Scholarship Application

Prison Fellowship Angel Tree™ is pleased to provide scholarships to allow children with incarcerated parents or stepparents to attend camp at little to no cost. Please fill out one sheet per family.

Parent/Caregiver's Name*

First Name

Last Name

Parent/Caregiver's Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Parent Caregiver's Phone Number*

Parent / Caregiver's Relationship to Child*

How Many kids will you be registering

Incarcerated Parent's Information

(Must be complete name and last known facility or facility released from for scholarship purposes.) *This information WILL NOT be shared with the child.

Incarcerated Parent's Name*

First Name

Last Name

Incarcerated Parent’s Last Known Location: Prison Name*

State*

State

Year Released (If applicable)

Acknowledgements

When participating in the Angel Tree® associated camp (the “Camp”), I acknowledge that my child may be photographed for print, videotaped, or electronically imaged (Images) and that my child’s first name and biographical information, and/or comments and quotes may be obtained (Statements); and that such Images and Statements (Materials) may be used by Prison Fellowship and/or the Camp in promotional materials, news releases, websites, and other published formats. I hereby release Prison Fellowship and the Camp, and anyone working on their behalf from any and all liability, claims, and causes of action that I might have arising out of the use of such Materials, to include rights of publicity and privacy. The Materials will be the sole property of Prison Fellowship and/or the Camp. I also acknowledge and understand that as the Caregiver, it is my sole decision to permit my child to participate in a camping program, to select the Camp that is right for my child, and to ask questions of the Camp as to suitability, including information on the Camp’s programs, values, child safety guidelines, counselors, activities, and any special needs my child may have.

Parent/guardian of the participating child hereby grants Prison Fellowship Ministries (“PFM”) its affiliates and agents, irrevocable permission to use, record, and reproduce the image and likeness of his/her participating child in any manner and in all media now or hereafter known, for any and all purposes (including advertising and promotional use), in perpetuity throughout the world, without restriction as to alteration. Parent/guardian and participating child give this consent with no claim for payment.

I agree and understand the above terms*

Yes

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

:

Child 1 Info

Child Name*

First Name

Last Name

Date of Camp Attending*

Which Camp will the Child Attend? - Child 1*

The Ranch (New York) The Ridge (New York) The Island (New York) The Coast (Florida)

Child Date of Birth*

Grade the child will be entering this fall:*

The child does not have an incarcerated parent but lives in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.) The child does not have an incarcerated parent and does not live in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.)

Child 2 Info

Child Name*

First Name

Last Name

Date of Camp Attending*

Which Camp will the Child Attend?*

The Ranch (New York) The Ridge (New York) The Island (New York) The Coast (Florida)

Child Date of Birth*

Grade the child will be entering this fall:*

The child does not have an incarcerated parent but lives in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.) The child does not have an incarcerated parent and does not live in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.)

Child 3 Info

Child Name*

First Name

Last Name

Date of Camp Attending*

Which Camp will the Child Attend?*

The Ranch (New York) The Ridge (New York) The Island (New York) The Coast (Florida)

Child Date of Birth*

Grade the child will be entering this fall:*

The child does not have an incarcerated parent but lives in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.) The child does not have an incarcerated parent and does not live in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.)

Child 4 Info

Child Name*

First Name

Last Name

Date of Camp Attending*

Which Camp will the Child Attend?*

The Ranch (New York) The Ridge (New York) The Island (New York) The Coast (Florida)

Child Date of Birth*

Grade the child will be entering this fall:*

The child does not have an incarcerated parent but lives in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.) The child does not have an incarcerated parent and does not live in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.)

Child 5 Info

Child Name*

First Name

Last Name

Date of Camp Attending*

Which Camp will the Child Attend?*

The Ranch (New York) The Ridge (New York) The Island (New York) The Coast (Florida)

Child Date of Birth*

Grade the child will be entering this fall:*

The child does not have an incarcerated parent but lives in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.) The child does not have an incarcerated parent and does not live in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.)

Child 6 Info

Child Name*

First Name

Last Name

Date of Camp Attending*

Which Camp will the Child Attend?*

The Ranch (New York) The Ridge (New York) The Island (New York) The Coast (Florida)

Child Date of Birth*

Grade the child will be entering this fall:*

The child does not have an incarcerated parent but lives in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.) The child does not have an incarcerated parent and does not live in the same household with another child who has an incarcerated parent. (Check the box if this statement is true.)