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2. Dear Applicant
   Please complete the following information and email it to Parks and Recreation, fax it to 360-755-1017, or mail to:
   Parks and Recreation Department
   900 E. Fairhaven Ave.
   Burlington, WA 98233
   
   Please allow at least 14 days in advance of the program date for processing.
   
   Please make not that scholarships offered by the foundation are available for classes or camps where registration is conducted directly through Burlington Parks and Recreation Department. It is not available for programs offered by organizations that contract with the parks and recreation for use of its facilities. Examples would be the Kidz Love Soccer, Skyhawks, and British Challenger programs.
4. Date of Application
   Date of Application
5. School District
7. Participant One
9. Name
10. Birthdate
    Birthdate
11. Program Name
13. Program Start Date
    Program Start Date
14. Program Fee
16. Participant Two
18. Name
19. Birthdate
    Birthdate
20. Program Name
22. Program Start Date
    Program Start Date
23. Program Fee
25. Name of Parent or Guardian
    If Under 18
27. Daytime Phone Number
28. Email
30. Mailing Address
32. Address 2
34. City
35. State
36. Zip
38. Reason for Financial Assistance Request
40. Total Amount You Can Contribute
41. Have You Made Previous Requests for Financial Assistance

    1. Yes
    2. No
43. Please List Dates and Activities
45. Name of Person Submitting Application
46. Daytime Phone Number
48. Email Address
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58. Print Only

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