| Application
for Free One Week Scholarship to
McKinney Roughs Summer Camp Program
Please
print, complete and mail this form to City of Bastrop Public Works, Parks and Recreation Department, Attn: Amanda Phillips at P.O. Box 427, Bastrop,
Texas 78602.
Applications must be received no later than Monday, March
31, 2008. |
Please print legibly:
Child's Name: _________________________________________________Age:
___________
Grade Level: ________________Child's
Date of Birth: ________________Gender: _________
School Attending: _____________________________________________________________
| Parents'
Names: |
___________________________________________ |
| |
(Mother/Stepmother/Guardian) |
| |
___________________________________________ |
| |
(Father/Stepfather/Guardian) |
Child's Address: _______________________________________________
(must submit proof**) Street or P.O. Box number
City and State: __________________________Zip
Code: _____________________
**Please submit proof of child’s residency within Bastrop
city limits, such as a copy of the child’s birth certificate or
your proof of guardianship PLUS your City of Bastrop utility bill. These
will be shredded once verified. If you prefer not to attach copies, please
bring these items with your application to the Public Works & Parks
Department for verification and submission.
E-Mail Address: _______________________________________________(please
print legibly)
Home Phone Number:
_________________________
Cell Phone Number(s): _________________________
Parents Work Number: _________________________
|