All information is for Parks & Recreation use only.

Village of Archbold Department of Parks & Recreation
300 N. Defiance Street
Archbold, OH 43502

* required field

Edit Form

Scholarship Form

Child's Name*

Child's Date of Birth*

Gender* --Select One-- Male Female

School*

Grade* --Select One-- K 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Parent's/Guardian's Name*

Street Address*

City*

Zip*

Phone*

Alternate Phone

Email Address

Program Name* --Select One-- Youth Basketball Spring Soccer Flag Soccer Flag Football Junior High Baseball Junior High Softball T-Ball Tiny Tots Baseball Little League Softball 12 & Under Softball 14 & Under Softball 7 yr Olds Baseball Pee Wee Baseball City League Baseball Little League Baseball Pony League Baseball Jr. Acme Baseball Spring Junior High Baseball Spring Junior High Softball Tournament Entries

Program Season* --Select One-- Spring Summer Fall Winter

Do you participate in the school's free and reduced program?

Free Lunch Participant

Reduced Lunch Participant

Must be selected if choosing either of the lunch programs above

I authorize the Archbold Area School District to release information regarding free/reduced lunch program participation to the Village of Archbold Department of Parks & Recreation.

Please make applicable selections

I understand that if I qualify for the Free Lunch program that I will be required to pay for 25% of the registration fee.

I understand that if I qualify for the Reduced Lunch program that I will be required to pay for 50% of the registration fee.

I understand that my child will be eligible for two scholarships per year and that I am responsible for the registration fees for all subsequent programs this calendar year.

I understand that program scholarships are distributed on a first come first serve basis and that I am not guaranteed a scholarship for any program.

Please give a brief explanation of why you would like your child to receive a scholarship*

*

I certify that the above information is true and complete to the best of my knowledge. I understand that scholarship assistance is based on need and financial need does not automatically guarantee selection.