Shanta Strong Swim Lesson Scholarship Application

Child(ren) Information

Enter information for the child or children you are applying for.

Child 1- First Name   Enter the first name of the first child you are applying for.

Child 1 - Last Name   Enter the last name of the first child you are applying for.

Child 1 - Date of Birth   Select the date of birth for the first child you are applying for.

Child 2 - First Name Enter the first name of the second child you are applying for.

Child 2- Last Name Enter the last name of the second child you are applying for.

Child 2 - Date of Birth Select the date of birth for the second child you are applying for.

Child 3 - First Name Enter the last name of the third child you are applying for.

Child 3 - Last Name Enter the last name of the third child you are applying for.

Child 3 - Date of Birth Select the date of birth for the third child you are applying for.

Child 4 - First Name Enter the last name of the fourth child you are applying for.

Child 4 - Last Name Enter the last name of the fourth child you are applying for.

Child 4 - Date of Birth Select the date of birth for the fourth child you are applying for.

Child 5 - First Name Enter the last name of the fifth child you are applying for.

Child 5 - Last Name Enter the last name of the fifth child you are applying for.

Child 5 - Date of Birth Select the date of birth for the fifth child you are applying for.

Proof of Attendance at a Title 1 School, Medicaid, or SNAP.   Only proof of 1 of the above needs to be provided. No larger than 7.9 mb

Parent or Guardian Information

Enter your information

Parent or Guardian First Name   Enter your first name.

Parent or Guardian Last Name   Enter your last name.

Parent or Guardian Date of Birth   Enter your date of birth.

Your E-Mail Address  

Phone Number   Use format xxx-xxx-xxxx.