Parent First Name *

Parent Last Name *

Contact Email *

Contact Phone Number *

Number of children in family playing SCUFC/YMCA Recreational Soccer *

Player's Name(s) - Please list the names of all children playing *

Venue Playing *

Household Income *

Amount to be paid by applicant/child *

Federal or State Aid you are currently receiving (please select all that apply) *

Please list any UNUSUAL financial obligations or hardships (i.e. Medical bills, recent loss of job).

I agree that everything stated in the above application is correct to the best of my knowledge. I also agree to provide verification of income, if requested. *

I understand that I must be current with any outstanding balances due to SCUFC or SCUFC/YMCA before I will be awarded further assistance. I also understand that Payment of any balance due on the account MUST be paid in full before my child will be allowed to practice/participate in games. All decisions of the Financial Assistance Committee are FINAL. *