BDA Reduced Fee/Tuition Waiver Form

BDA Camp or Class 1st Choice: *

2nd Choice *

Student's Name *

First Name Last Name

Age *

Birth Date *

Month Day Year

What Grade will your child be going into? *

K 1 2 3 4 5 6 7 8

Please check a box *

Male Female

Parent orGuardian Name 1 *

First Name Last Name

Parent or Guardian Name 2

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Primary Phone *

Area Code Phone Number

Another Phone

Area Code Phone Number

Parent E-mail *

Do parents reside in same household? *

Yes No

Marital Status: *

Married Divorced Separated Single

Number of adults in household *

Number of children in household *

Does your family qualify for the Federal Free School Lunch Program? *

Yes No

Yearly Family Income *

Adjusted Gross Income *

Special Financial Considerations (please describe)

What percentage of tuition reduction are you requesting *

100% 75% 50% 25%

Could you contribute to your child's or teen's tuition in other ways?

Volunteer Supplies Other

Proof of Income is required *

Most Current Tax Return Current W2 Form DWS Financial Benefit Statement Employer Verification Statement Housing Authority Annual Income Form Other

Upload your Proof of Income (PDF files work best)

You may also Mail your Proof of Income to Bad Dog Arts 824 South 400 West, Suite B129, Salt Lake City, Utah 84101

You can also Drop It By the Bad Dog Arts Office (same address)

Note:

I understand that all information I provide is private and confidentail. By my signature below, I acknowledge that all of the above information is accurate and true.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

INSTRUCTIONS: You can sign by using your finger on a laptop with a trackpad, or a tablet (like the Apple iPad or Samsung Galaxy) You can also sign using a mouse on a regular computer.

Signature *

Clear