Parent/Guardian Name/Adult Participant's Name First Name * Last Name * Address * Phone Number * ( Phone Number, part 1 ) Phone Number, part 2 Phone Number, part 3 Email * Child's Name (If applicable) First Name Last Name Child's Date of Birth (if applicable) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Which program would you like to attend? * Half Day Summer Camp (Ages 4 - 6) Full Day Summer Camp (Ages 6 - 12) Skills Full Day Summer Camp (Ages 10 - 12) Overnight Summer Camp (Ages 11 - 18) Teen Wolf Tracking Expedition (Ages 13 - 18) Roots and Wings (Ages 4 - 6) Foxes (Ages 7 - 9) Coyotes (Ages 10 - 11) Village (Ages 7-11) Community School (Ages 12 - 18) Monthly Program (Ages 4 - 13) Wild Within (Ages 14 - 18) Anake Leadership Program Tracking Intensive (Up to 20% scholarship) Wild Plant Intensive (Up to 20% scholarship) What location(s) would you like to register for? (check all that apply) * Seward Park (Seattle) St. Edward State Park (Kenmore) Cougar Mountain (Issaquah) Tolt-McDonald Park (Carnation) Wilderness Awareness Campus - Linne Doran (Duvall) Amount Requested * (Maximum 50% of Program Cost) % Annual Household Income * $ (no comma, round to nearest thousand, Ex: 32000) Do you forsee this changing in the next 6 months? * No Yes Size of Household * Why do you/your child want to participate? * Financial Situation * Please describe your financial situation and why you feel that you need this scholarship in order for your child to participate.