Sponsorship Application Parent Disclosure Form

Club Name *

Club Type *

Parent/Legal Guardian Name *First and Last Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Email Address

Sponsorship Candidate(s)Complete Information for Each Individual Needing Sponsorship

Name *First and Last Name

Age *

Gender (Male/Female) *

Grade *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Club Membership *PathfinderAdventurer

Club Class Level

Baptized by Immersion *YesNo

Church Member *YesNo

Annual Household Income Level *

Monthly Household Expenses *

Number of Household Members *

Monthly Household Government Assistance *Does your household receive monthly government assistance?

Agreement & Certification *The information I provided is true and accurate to the best of my knowledgeI approve of my child’s consideration for sponsorship grant moneyI agree to provide any additional follow-up/reporting documentation as required

File UploadUpload Any Additional Files (Supporting Documents, Quotes, Invoices, Photos)