BDA Reduced Fee/Tuition Waiver Form

BDA Reduced Fee/Tuition Waiver Form
BDA Camp or Class 1st Choice:*
2nd Choice*
Student's Name*

First NameLast Name
Age*
Birth Date*

MonthDayYear
What Grade will your child be going into?*

K12345678
Please check a box*

MaleFemale
Parent orGuardian Name 1*

First NameLast Name
Parent or Guardian Name 2

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Primary Phone *

Area CodePhone Number
Another Phone

Area CodePhone Number
Parent E-mail*
Do parents reside in same household?*

YesNo
Marital Status: *

MarriedDivorcedSeparatedSingle
Number of adults in household*
Number of children in household*
Does your family qualify for the Federal Free School Lunch Program?*

YesNo
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?

VolunteerSuppliesOther
Proof of Income is required*

Most Current Tax ReturnCurrent W2 FormDWS Financial Benefit StatementEmployer Verification StatementHousing Authority Annual Income FormOther
Upload your Proof of Income (PDF files work best)

Upload a File

Cancelof
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
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