Scholarship Form - Sports Club Naples (Page 3 of 3) in pdf

Parent Responsibilities:

**Initial each line as your read**

I will report the following changes to Sports CLUB within 10-calendar days:

A. _______ Change of employment for any household member.

B. _______ Change in employment status (i.e. wages and hours).

C. _______ Changes in residence or mailing address.

D. _______ Loss or addition of a household member.

E. _______ Changes in parent’s school attendance/class schedule.

I understand that my child must:

A. _______ Attend a minimum of 12 day per month.

B. _______ If child/children exceeds the allowed number of absent days, the parent must provide documentation

with explanation (i.e. doctors note).

I am responsible for paying my own childcare until:

A. _______ Determined to be eligible for assistance.

B. _______ Letter of approval has been issued from scholarship committee.

C. _______ Funding becomes available and family is selected from a waiting list.

I understand that I must submit payment for all parent fees and understand the following conditions:

A. _______ Annual $40 registration fee must still be paid in full by parent.

B. _______ Weekly payments are due the first day my child/children attend each week.

C. _______ Account must stay current and not become past due.

I understand that my Sports CLUB scholarship can be terminated if:

A. _______ My family becomes ineligible.

B. _______ Program funds become unavailable.

C. _______ Non-payment/past due account.

D. _______ Child attendance is below 12 days per month.

I understand that I must:

A. _______ Re-submit updates income verification by May 1

of the current year to continue scholarship

throughout summer months.

B. _______ I understand that with failure to re-submit information by May 1

, my scholarship will become

inactive after the last day of school of the current year.

By signing below, the applicant attests that the foregoing is true and accurate. The applicant acknowledges that he/she

subjects his/herself to all criminal and civil liability that may arise from submitting a false application. The applicant

acknowledges that should any forgoing information be false, the applicant is liable for repayment to Sports CLUB for ant

costs and funds given to the applicant.

Printed Name of Applicant: ___________________________________________________________________

Signature of Applicant: ______________________________________________________________________

Date: _____________________

Scholarship Form - Sports Club Naples Page 3