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Fee Waiver Application
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* Indicates required question
Email
*
Your answer
Parent(s) Name(s)
*
Your answer
Performer 1 Name/Age
*
Your answer
Performer 2 Name/Age
Your answer
Performer 3 Name/Age
Your answer
Performer 4 Name/Age
Your answer
Performer 5 Name/Age
Your answer
Production Name
*
Your answer
Performer Home Address
*
Your answer
Performer School
*
Your answer
Annual Gross Yearly Income of Household
*
Your answer
Do you currently receive any financial assistance (ie: food stamps, cash assistance, free or reduced school lunches)? If yes, please describe.
Your answer
List All Members of Your Household & Ages:
*
Your answer
Other Info Relevant to Your Current Financial Situation:
Your answer
By submitting this form, I verify that all of the information provided here is true and accurate to the best of my knowledge. I also understand that verification of all information provided may be required.
*
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Required
Today's Date:
*
MM
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YYYY
Electronic Initials
*
Your answer
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This form was created inside of Harrisburg Christian Performing Arts Center.
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