2024 Aquaminnies w/ Kristen - Scholarship Application
Kristen King
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Email *
Full name of parent/caregiver: *
CHILD 1 -Full name, Date of Birth, and age
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CHILD 2 (If applying for multiple children) -Full name, Date of Birth, and age
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CHILD 3 (If applying for multiple children) -Full name, Date of Birth, and age
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Are there any other children living in the home? Please list their ages.
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Address:
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Phone Number:
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Annual gross income (You may be asked to provide further documentation)
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Please list your MONTHLY Income:
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List out MONTHLY expenses: 
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Do you own more than one property or home?
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Do you currently have any memberships to any amusement parks/museums/zoos, etc..?
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Do you currently pay for any sports/dance/activities for your children? If yes, please describe. 
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Are you able to contribute to the cost of lessons? If so, please put amount you are able to contribute per week. (The total number of lessons/weeks is determined by the instructor. The total cost per week is $100.)
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When are you looking to start lessons?
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Do you own a pool; have a body of water within 250ft of your home; or frequently visit a home with a pool?
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Are there any medical or behavioral considerations, including any traumatic water experiences/non fatal drowning incidents. Has there been a fatal drowning in your family? If yes, please specify which child and date of incident.
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You have chosen to have lessons with Kristen King. Have you been in touch with her to schedule lessons yet?
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I agree, that by accepting scholarship funds from SWIM for CJ Inc. that I will commit fully to 4-6 weeks of lessons, or as scheduled by instructor, and will avoid the use of floaties/puddle jumpers/water wings, etc while in a pool. I will use coast guard approved life vests when my child is in or near open water.
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I understand that scholarship funds may be limited at times and that I may be placed on a wait list for funding. Scholarship recipients will be chosen based off of financial need and water safety risk level, as determined by the board of SWIM for CJ Inc.
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By accepting a scholarship from SWIM for CJ, you also give permission for us to photograph your child and use their picture on social media and marketing materials.
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Please provide any additional information that may help us make a determination in your scholarship approval. 
A copy of your responses will be emailed to the address you provided.
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