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Youth Fundraising Program
Date
/
Month
/
Day
Year
Date
Referral Pay Code
Enter Full Name (or Code) of Parent who Referred You.
Parent #1
*
First Name
Last Name
Parent #2
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Child's Name
*
First Name
Last Name
Upload Picture of Student/Athlete
Browse Files
Cancel
of
Age of Child
School Child Attends
Child's Current Grade Level
Payment/Payout Information
Checks are written directly to the Parent(s). Please enter the name your check should be written to.
Payouts every 2 weeks
Address (If you want your fundraising check mailed)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Bank if you want Direct Deposit
For Direct Deposit (Only)
Account Number
Routing Number
Fundraising Start Date
What Date would you like to Start your Fundraiser?
/
Month
/
Day
Year
Fundraising Period runs every 2 weeks.
Submit
Should be Empty: