Swim Scholarships Swim Scholarships Swim Scholarship Application Please apply below to receive one of our swim lesson scholarships. "*" indicates required fields Parent/Guardian Name* First Last Relationship to Student*Student Name* First Last Student Date of Birth* Month Day Year Student Age*Street Address* Street Address Address Line 2 City State ZIP / Postal Code Parent/Guardian Phone*Parent/Guardian Email* Is there a pool, pond or lake at or near the home?* Yes No Have you previously applied for a scholarship?* Yes No Has the child has swim lessons before?* Yes No Who was the previous instructor?* Yourself Your child or children Another family member How many people are in the household?*Ages of ChildrenSeparate ages with a comma.Annual household income level?*Please provide a brief description to support your child’s need for a Swim Scholarship.*Preferred instructor?How did you hear about us?*Scholarship recipients must attend ALL classes during the designated class session. Failure to attend will result in dismissal and no future assistance. Parent Responsibility: A parent must register for swim lessons with the swim school or pool within 60 days of the award of the scholarship or you will lose the scholarship. Each parent is responsible to inform Smile Like Aubrey if there is a health issue with the student. It is also the parents responsibility to arrange transportation to and from the lessons. Parents will also follow all instructions given by the instructor/facility where the lessons are given. Photo/Video Release: By accepting a scholarship from Smile Like Aubrey you are giving consent for yourself and/or your child to be photographed by Smile Like Aubrey or one of its agents while participating in the swimming lessons. This may be used for advertising or promotional pieces. Liability Release: I expressly acknowledge, on behalf of myself and my heirs, that I will assume the risk of any and all injuries and illness as a result of participation in the swimming lessons. I realize that Smile Like Aubrey is simply providing financial support in order to receive Basic Survival Swimming Lessons. Medical Requirements: Some medical conditions may require a physician or therapist note for participation in the programs. Please make the instructor/facility aware of any potential issues. Registration Fees: Parents are solely responsible for any registration fees that may be required by the instructor, regardless of the amount of scholarship provided by Smile Like Aubrey. Smile Like Aubrey may offer to reimburse the parent any registration fees upon notification from the instructor that the child has completed all of the lessons. If the child does not complete all of the lessons, the parent will not be reimbursed for any registration fees. Smile Like Aubrey will notify the parent directly when awarding your child a scholarship if the scholarship will include reimbursement for registration fees based upon the above guideline. By checking the box below, you are acknowledging that you have read and agree with the release information above and wish to accept a swimming scholarship from Smile Like Aubrey if one is offered.Acknowledgment* Yes, I agree. CaptchaNameThis field is for validation purposes and should be left unchanged.
