Financial Aid - Parks and Rec programs

2. Parent or Guardian First Name*
3. Parent or Guardian Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Daytime Phone Number*
14. Cell Phone Number
16. Work Phone Number
17. Extension
18. Date of Birth
    Date of Birth
20. Email Address*
21. Type of Aid

    1. Self
    2. Child(ren)
    3. Additional Adult
22. Child(ren)'s Address

    1. Same as adult's
    2. Different address
24. Child(ren)'s Address1
26. Child(ren)'s Address2
28. Child(en)'s City
29. State
30. Zip
34. Additional Adult First Name
35. Additional Adult Last Name
36. Date of Birth
    Date of Birth
38. Additional Adult Address1
40. Additional Adult Address2
42. Additional Adult - City
43. Add'l Adult - State
44. Add'l Adult - Zip
46. Verification Release
    By submitting this form, I confirm that my child(ren) participate(s) in the Rutherford County School System school lunch program as Free or Reduced. I hereby authorize the Rutherford County School Systems from all liability for releasing said information. I hereby release the City of Murfreesboro from all liability associated with the gathering, use, and/or release of any information relative to my eligibility for financial assistance. I understand that any information possessed by the City of Murfreesboro and/or the Murfreesboro Parks and Recreation Department is public record under the Tennessee Public Records Law, T.C.A. Section 10-7-501 et Seq. I give my permission for any photos or video footage of myself and/or my child or ward taken during the course of this sport or activity to be used for educational, promotional, or any other purpose.
48. Minor Information
    Requirements: Ages 18 and under, still in school
50. First Name
51. Middle Initial
52. Last Name
54. Age
55. Date of Birth
    Date of Birth
56. Sex

    1. Male
    2. Female
58. School
59. Grade
60. Lunch Program

    1. Free Lunch Program
    2. Reduced Lunch Program
64. First Name
65. Middle Initial
66. Last Name
68. Age
69. Date of Birth
    Date of Birth
70. Sex

    1. Male
    2. Female
72. School
73. Grade
74. Lunch Program

    1. Free Lunch Program
    2. Reduced Lunch Program
78. First Name
79. Middle Initial
80. Last Name
82. Age
83. Date of Birth
    Date of Birth
84. Sex

    1. Male
    2. Female
86. School
87. Grade
88. Lunch Program

    1. Free Lunch Program
    2. Reduced Lunch Program
92. First Name
93. Middle Initial
94. Last Name
96. Age
97. Date of Birth
    Date of Birth
98. Sex

    1. Male
    2. Female
100. School
101. Grade
102. Lunch Program

     1. Free Lunch Program
     2. Reduced Lunch Program
106. First Name
107. Middle Initial
108. Last Name
110. Age
111. Date of Birth
     Date of Birth
112. Sex

     1. Male
     2. Female
114. School
115. Grade
116. Lunch Program

     1. Free Lunch Program
     2. Reduced Lunch Program
120. First Name
121. Middle Initial
122. Last Name
124. Age
125. Date of Birth
     Date of Birth
126. Sex

     1. Male
     2. Female
128. School
129. Grade
130. Lunch Program

     1. Free Lunch Program
     2. Reduced Lunch Program
134. First Name
135. Middle Initial
136. Last Name
138. Age
139. Date of Birth
     Date of Birth
140. Sex

     1. Male
     2. Female
142. School
143. Grade
144. Lunch Program

     1. Free Lunch Program
     2. Reduced Lunch Program
148. First Name
149. Middle Initial
150. Last Name
152. Age
153. Date of Birth
     Date of Birth
154. Sex

     1. Male
     2. Female
156. School
157. Grade
158. Lunch Program

     1. Free Lunch Program
     2. Reduced Lunch Program
Leave This Blank:


160. 1. Receive an email copy of this form.
161. Email address

     This field is not part of the form submission.

162. Submit Submit and Print

* indicates a required field