BRENHAM DOLPHIN SWIM TEAM - 2008

REGISTRATION SCHOLARSHIP APPLICATION

Please complete the following information, one application per child:

Athlete’s Name: __________________________Age: ______ Male/Female    Birthdate:_____________________

Address:_______________________________________________________________________________

Street___________________________ City_________________________ State______ Zip____________

School Athlete Attends: ________________________________________________Grade:______________

Athlete lives with: (   ) Both Parents (   ) Mother (   ) Father (   ) Other

Amount of scholarship requested: Full $ ___________Partial $  ____________

PARENT / GUARDIAN INFORMATION:

Total Household Annual Income: $___________________

Number of dependent children in your household during the last tax year:

Father’s Name: _____________________________Occupation:____________________________

Home Phone: ____________________Work Phone:__________________ E-mail: ________________________

Mother’s Name: ____________________________Occupation: ____________________________

Home Phone: ____________________Work Phone:__________________ E-mail: ________________________

Guardian’s Name:___________________________Occupation:____________________________

Home Phone: ____________________Work Phone:__________________ E-mail: ________________________

I understand that my child(ren)’s participation in this program requires a

commitment to attend a minimum of 80% of the scheduled practices and games.

Parent/Guardian Signature:______________________________________ Date:________________________

League Administrator Signature:  _________________________________ Date:________________________

Scholarship funds are intended to cover the registration cost for youth sports programs.

Scholarships do not include swim suit and goggles.

Information provided by scholarship applicants will remain confidential. 2006 or 2007 Tax return required