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.

    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

    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