Waterbabies Scholarship Application

It is the policy of Waterbabies Aquatic Program to make program opportunities available to all interested people,

regardless of income. We provide scholarships to those who might not otherwise be able to participate. Scholarships

may be granted for up to 50% of the class fee depending on individual circumstances. All information will remain confidential.

To be eligible for a scholarship you must show a financial need. Scholarship applications must be approved prior to registration.

Please write in the box below why you should be awarded a scholarship include a brief description of your personal circumstances

that make this necessary.

Parent/Guardian First Name	Parent/Guardian Last Name	Child Name	Childs Date of Birth
Are you New to Waterbabies:
How long have you been swimming with Waterbabies?
Please briefly describe your personal circumstances in the box below:

Address: State: Zip Code:

City: Phone Hm.

Phone Wk. Cell Phone:

E-mail Address

Please Indicate Family Size:

Yearly Income (Before Taxes):

I certify that the above information is correct to the best of my knowledge. I understand that any additional fees (i.e., registration fee, equipment) are my own responsibility.

Signatures:_________________________________ Date:___________________________________