2017 Application for Assistance
Child's Name *
Your answer
Age *
Your answer
Sex *
Required
Grade in School *
Your answer
Sport *
Your answer
Sports Organization *
Your answer
Receive Food Stamps *
*If you answer yes, you must submit food stamp verification to kaley@pagnozzicharities.org 2 weeks prior to sports registration deadline.
Required
List all Household Members / Ages / all Income for the past 30 days *
Must submit proof of all income listed which may include pay stubs, welfare, child support, alimony, pensions, retirement, social security, etc. to kaley@pagnozzicharities.org 2 weeks prior to the sports registration deadline.
Your answer
Parent (guardian) Name *
Your answer
Phone Number 1 *
Your answer
Phone Number 2
Your answer
Address / City / State / Zip *
Your answer
Email Address *
Your answer
Name of Child's School *
Your answer
County of Residence *
Your answer
Child's Racial and Ethnic Orientation (Optional)
Today's Date *
MM
/
DD
/
YYYY
Have you already registered for the sport for which you are applying for assistance? *
We recommend registering for the sport and letting the organization know that you have applied for our assistance. We need a copy of your sports registration form 2 weeks prior to the registration deadline.
Required
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