Low Income Qualification Requirements

"*" indicates required fields

Number of members in my family (including myself) that I am supporting:

"I", (Name)*

have earned $*

within the last 12 months.

I/We,*

am/are the lawful custodial parent(s) and/or non-custodial parent(s) or legal guardian(s) of:

Name*

Date of Birth*

Male or Female*

Male

Female

Other

Disabilities-Please List: (Must complete disability forms if applicable)*

I/We authorize my child to travel with the following adult(s):

Adult Name

Relationship

Adult Name

Relationship

Absolutely no minors travel alone. All minors (regardless of age) and accompanying adults must have a completed registration form on file.

Full Name*

Date of Signature*

Parent / Legal Guardian Signature:*

248-887-4979