2023 Camp & Recreation Scholarship Application

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Camp & Recreation Scholarship Application

To encourage families to enroll children and adults with spina bifida in community-based recreational activities, the Spina Bifida Coalition of Cincinnati offers individuals living in our service area up to $300/calendar year for program fees.

Some examples of programs that are eligible:

Scout Camps
Specialized Camps for those with Disabilities
Recreational Programs
Art Therapy Camp
Adapted Sports Programs or Lessons

Date*

Name of Individual with spina bifida*

Date of Birth of Individual with Spina Bifida*

Gender*

First Name of Person Completing Form*

Last Name of Person Completing Form*

Address, line 1*

Address, line 2

City*

Zip Code*

County*

State*

Email Address*

Contact Name and Phone or Email for Program*

Mailing Address of the Camp or Program*

Date(s) of Camp or Program*

Cell Phone*

Yes, I would like to receive occasional text messages!
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Amount Requested*

Payable To*

Additional Comments/Other Information

This form must be submitted with supporting documentation (registration form or invoice) prior to payment. Registration form or invoices can be emailed to info@sb-coalition.org or texted to 513-923-1378. An acknowledgement will be sent to you when payment is made.

Camp and recreation scholarships are offered on a first come, first served basis, annually.

SUBMIT APPLICATION

Name
Address Line 1, Address Line 2
City, State Zip Code
Cell Phone
Contact Email