Family Reference Form

To be completed by someone familiar with the family and their financial need within the last year.

Camper's First Name *

Camper's Last Name *

How long have you know 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 additional information that may be pertinent related to this camper receiving a scholarship to attend Camp Pinnacle. *

Reference First Name *

Reference Last Name *

Reference Email *

Reference Home Phone

Reference Cell Phone *

Signature

Date

If you are human, leave this field blank.

Contact Us

4125 Old Milton Pkwy
Alpharetta, GA 30005
(770) 960-9643
pinnacle@gabaptist.org
georgiabaptistwomen.org