2013 CAMP FEES SPONSORSHIP REQUEST FORMW A I H O L A

• An enrolment form and sponsorship request is required for each camp and child must be enrolled prior request being made.• All sections are required to be filled in - unfortunately we cannot process incomplete sponsorship request forms and as a result your child could miss out on recieving sponsorship

The purpose of the sponsorship fund is to help families out that can’t a�ord camp fees but don’t qualify for other funding

SOME BASIC DETAILS

STEP 1

P l ease t e l l us why you need sponsorsh ip for camp fees :

Have you comp l e t ed a camp enro lment form for th i s camp?Yes Please complete an enrolment form before continuingNo

Name of Camp At tend ing :

Dates of Camp At tend ing :

Camper ’ s Name :

Your Fu l l Name :

Your Pos ta l Address :

Your Phone Number :

Your Ema i l Address :

Your re lat i onsh ip to camper :

STEP 2

OSCAR CHILDCARE SUBSIDYHave you ever app l i ed to Work and Income for the OSCAR ch i l d care subs id y?

No

Do you have one ch i l d and your week ly fami l y income before tax i s l e ss than $ 1400?

Do you have two ch i l dr en and your week ly fami l y income before tax i s l e ss than $ 1600?

If you answer yes to any one of the above questions, then you may qualify for OSCAR subsidies towards camp fees - please call 0800 559 009 to arrange an OSCAR form to be sent to you, complete it and let the CYC office know if you are applying.

Yes

Yes Please apply for OSCAR subsidies again by calling 0800 559 009 to arrange an OSCAR form to be sent to you and ask for the request to be put on record1. Complete the form and return it to Work and Income before camp starts. 2. Let the CYC office know if you are applying.

You will then need to wait until after the camp is over and the OSCAR subsidy has been approved (or declined) with subsidy payments made before you applying for sponsorship if you still require it.

P l ease t e l l us why the OSCAR subs id y was dec l i n ed . . .No

Does your fami l y have at l eas t one parent/careg iver can s tay home and care for the ch i l dr en during the week of camp?

Yes It is likely you do not qualify for OSCAR subsidies - however you can still call 0800 559 009 to check

No Please answer the following questions...

Do you have three or more ch i l dr en and your week ly fami l y income before tax i s l e ss than $ 1800?

Do you have spec ia l c i r cumstances where you need to care for a s i ck par tner or need to at t end regu lar med i ca l t r eatments?

Have you ever qua l i f i ed for the OSCAR subs id y?

Please note: • OSCAR Child-care subsidies are applied based on family income and work/study hours and may not cover full camp fees.• For more information about OSCAR subsidies and current income rates please visit: http://www.workingforfamilies.govt.nz/childcare-assistance/

STEP 3

OTHER FUNDING SOURCES

Is your fami l y assoc iat ed w i th or at t end a church?No

Yes

Please continue on to step four

Please give us your church details so we can seek sponsorship from them if available

Church Name :

Church Address :

Pas tor ’ s Name :

Pas tor ’ s Phone :

Pas tor ’ s Ema i l :

Is your fami l y assoc iat ed w i th or c l i en ts of any of the fo l l ow ing organ i sat i ons :Streng then ing Fami l i e s

Ang l i can Fami l y Care

Presby ter ian Suppor t

Sa lvat i on Army

Do any ch i l dr en in your fami l y curren t l y rece ive the Ch i l d Disab i l i t y Al l owance?No Yes All the children within the family will qualify for camp fees to be paid by Work and Income - please call 0800

559 009 to arrange and let the CYC office know.

STEP 4

FINANCIAL SITUATIONWhat i s your fami l i e s week ly income af t er tax?

Is anyone in your househo l d on a benef i t and i f so , wh i ch one?

How many peop l e are in your fami l y l iv ing at home?Adu l ts Teenagers ( 1 1 - 18 years o l d ) Ch i l dr en (0 - 10 years o l d )

How much can you afford to pa y towards the camp fees so that the sponsorsh ip fund can benef i t more?

STEP 5

Last Update : 1 1 December 20 12

DECLARATION• I dec lare that the supp l i ed informat i on i s correc t and accurat e t o the bes t of my know l edge .• I unders tand that the supp l i ed informat i on w i l l be kept conf i d en t i a l t o CYC off i c e s taff and used for the a l l o cat i on of sponsorsh ip funds on ly . I w i l l be kep t on f i l e for aud i t i ng purposes even af t er the camp has past .

Careg iver ’ s Name :

Careg ivers S ignature :

Date :

OFFICE USE ONLY:Rece ived Date :

Approved By :

Approved Resu l t : No Yes

Approva l Date :

Approved Amount :