Everyone's A Player

Providing Sports Opportunities
for Youth in the Merrimack Valley and Lowell

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EAP Application Form

To be completed by a parent or guardian

Child's Name: *
Parent/Guardian Name(s): *
Address:
Town: *
Home Phone:
Cell Phone:
Email Address: *
School:
Grade:
Date of Birth: *
Child's Age:
List Current Sports and/or After School Activities:
What Sport are You Applying For Funding:
Reason for Need of Assistance: *
How Many Family Members in Household:
Does your Family Qualify for Free or Reduced Lunch Under the National School Lunch Program? Yes or No *
Household Income:	$0-$29,000
	$30,000-$59,000
	$60,000-$89,000
	$90,000 or more