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Application to Waive Education Fees
Southeast Alabama Community Theatre
Please present a Federal Free/Reduced Lunch form, if applicable. Education programming space is limited, filled on a first-come basis, and may require an audition.
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Email
*
Your email
Which activity applies to this fee waiver?
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After-school class
Summer Camp
Competition Team
Production/Performance
What is the name of the activity? (ex. Descendants, Summer Camp Dothan Jul. 1-5, Acting I)
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Your answer
Contact Information
Name of Participant
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Your answer
Age
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Your answer
Date of Birth
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Your answer
Home Address (Include city, state, zip)
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Your answer
# of People living in the home
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Your answer
Mother/Stepmother Name
Your answer
Mother/Stepmother workplace
Your answer
Mother/Stepmother Best Phone
*
Your answer
Mother/Stepmother Email
Your answer
Father/Stepfather Name
Your answer
Father/Stepfather workplace
Your answer
Father/Stepfather Best Phone
Your answer
Father/Stepfather Email
Your answer
Medical Information
Does participant take any form of medication daily or on a regular basis?
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Yes
No
Required
Medication 1 (Include dosage, frequency, diagnosis)
Your answer
Medication 2 (Include dosage, frequency, diagnosis)
Your answer
Medication 3 (Include dosage, frequency, diagnosis)
Your answer
School Information
School participant attends:
Your answer
Grade (in or entering)
Your answer
Does participant receive any special academic services in school such as an IEP or is enrolled in a special services class for a learning disability, handicap, or other service?
Yes
No
SEACT provides fee waivers to eliminate financial barriers against participation.
Tell us WHY you need a fee waiver.
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Your answer
Is there an amount you are able to pay toward this program? Please tell us how much $______
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Your answer
I verify that all the information that I have documented on this application is true and correct to the best of my knowledge and that if asked, I can provide documentation of bills paid and checks received. My printed name indicates my agreement and signature.
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Your answer
Send me a copy of my responses.
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