*
Required
Parent/Guardian Full Name
*
required
Youth’s Full Name
*
required
School Attending
Daytime Phone
Email Address
Home Address
Address 2
City
State
Zip
(ex. 06108 or 06108-0809)
Activity Name
*
required
Activity Fee
*
required
Organization/Sponsor
Did you contact the sponsor organization for financial assistance?
Yes
No
Sponsor Amount
Applicant must contribute at least $5 toward the activity fee. There is a maximum scholarship of $100 per year, per person.
Family Amount Contributed
Amount Requested From Richfield R.E.A.D.Y.
Please send a confirmation email to the address below: