The Red Apple Fund: Summer Art Camp Grant Application Form

Please complete the below application by April 16, 2012. One form per child

Questions? Contact Saralyn Rosenfield at 302.571.9590 ext. 504 or redapple@delart.org.

*Required Fields

Child & Parent/Guardian(s) Information

*First Session Choice:

*Second Session Choice:

*Child's Name:

*Child's Age:

*Parent/Guardian Name(s):

*Street Address 1:

*City:

*Street Address 2:

*State:

*Zip:

*Home Phone:

*Work Phone:

*E-mail:

Cell Phone:

*Number of Children:

*Marital Status:

*Household Income:

*Relationship to child:

Emergency Contact Information

*Name:

*Phone:

Alternate Phone:

Payment in full must accompany registration unless applying for a Red Apple Fund Summer Art Camp Grant. If applying for a Summer Art Camp Grant, the parent/guardian will be notified whether one has been awarded by the week of April 25-27, 2012. If partial funding or no funding is awarded, payment will be requested at this time. The parent/guardian may also choose to cancel the registration.

*Have you received Red Apple funding before?

If so, when and for what class?

*Statement of Need (150 words maximum):

If your application is not accepted, do you wish to hold a spot and pay for the camp session of your choice after notification is received?
Yes No