Family Reference Form

Family Reference Form to be completed by someone familiar with the family and their financial need within the last year.

Camper's Name

First

Last

How long have you known the applicant?

What is your relationship to the applicant?

i.e. coach, teacher, etc.

Describe the financial need of the camper's family.

Do you have any concerns about this family's ability to pay the $50 deposit fee?

Yes

If yes, please explain.

Please share any other information that may be pertinent related to this camper receiving a scholarship to attend Camp Pinnacle.

Reference Name

First

Last

Reference Email

Reference Home Phone

Reference Cell Phone

Reference Signature

Date

If you are human, leave this field blank.