Survey - Campership Application - Pittsburgh Parks Conservancy

1.

Please enter your contact information

*

Name:

First Required	Last Required

*

Email: Required

*

Street 1: Required

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

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*2.

Question - Required - Camper name

(Maximum response 255 chars, approx. 5 rows of text)

*3.

Question - Required - Which school does your child attend?

*4.

Question - Required - Grade entering this fall

Pre-K

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

*5.

Question - Required - Please select all the weeks of camp that you would like to apply for your child. Most camps are 5 days. Camps with an asteric (*) are 4 day camps (No camp on June 19 and July 4). Note each camps are grade level specific: ~~~ Kinder - 4 years old to entering Kindergarten ~~~ Habitat Adventures - entering 1st or 2nd grade this fall ~~~ Nature Explorers - entering 3rd or 4th grade this fall ~~~ Outdoor Expeditions - entering 5th or 6th grade this fall ~~~ Survival - entering 7th or 8th grade this fall ~~~
Please make between 1 and 8 selections from the choices below.

	Morning Kinder Camp June 10
	Morning Kinder Camp June 17
	Morning Kinder Camp June 24
	Morning Kinder Camp July 1*
	Afternoon Kinder Camp June 10
	Afternoon Kinder Camp June 17,*
	Afternoon Kinder Camp June 24
	Afternoon Kinder Camp July 1*
	Habitat Adventures Camp July 15
	Habitat Adventures Camp July 22
	Nature Explorers Camp July 29
	Nature Explorers Camp August 5
	Outdoor Expeditions Camp June 24
	Outdoor Expeditions Camp July 1*
	Survival Camp June 10
	Survival Camp June 17*

*6.

Question - Required - Number of people in household

*7.

Question - Required - Total Annual Family Income. Please report ALL sources of income (Income, government assistance, etc.)

(Maximum response 255 chars, approx. 5 rows of text)

These questions are optional but are very helpful to us in striving to serve all Pittsburghers.

8.

Question - Not Required - Race

Asian

Black / African American

Hispanic

Multi-Racial

White

Other

9.

Question - Not Required - Other Race additional details

(Maximum response 255 chars, approx. 5 rows of text)

10.

Question - Not Required - Gender

(Maximum response 255 chars, approx. 5 rows of text)

11.

Question - Not Required - Primary language spoken at home

(Maximum response 255 chars, approx. 5 rows of text)

12.

Question - Not Required - Have you attended any of the Pittsburgh Parks Conservancy programs below? Check all that may apply.

	Allegheny Commons Park Programming
	Buzzword Homewood PGH Programming
	Hill District Programming, including August Wilson Park Programming
	Nature School at Crescent or COTRAIC preK
	Parks Rx

Campership Application

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