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Pathfinders Scholarship Request Form
Please complete the information below. A member of the PMC will review your request for Pathfinders Safe Swim Scholarship.
*Scholarships are issued on a first-come, first-enrolled basis.
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* Indicates required question
Parent Name
*
Your answer
Telephone #
*
Your answer
Email Address
*
Your answer
Child's Name & Age
*
Your answer
Which swim class are you interested in?
*
Private Lessons
Semi-Private Lessons
Group Classes for 1-3 year olds
Group Classes for 3-5 year olds
Group Classes for 5-10 year olds
Required
My child has been diagnosed with an intellectual disability and I'm interested in the $100 scholarship offered by Pathfinders for Autism.
Scholarships are issued on a first-come, first-enrolled basis.
*
Yes
No
I authorize PMC to take photos/videos of my child for the purpose of sharing with Pathfinders for Autism.
We'd love to showcase your child's achievements to inspire others. If permitted, this testimonial, photos, and videos would be provided to
Pathfinders for Autism
,
the donor of our swim scholarship, and shared with the PMC community.
*
Yes
No
When are you interested in your child starting?
*
Immediately (Current Session)
Fall (Next Session)
Winter/Spring
Additional Questions/Concerns/Comments:
Your answer
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