General Scholarship Application

Aspire Kids
Throw Me Something Healthy
Date: Monday, February 28th, 2022

Time: 9:30 a.m.- 3:00 p.m.

Ages: 5 to 12yrs old

Location: 8201 Kelwood Ave Baton Rouge, LA 70806

Office #: 225-272-5894

Educational Lessons, Art Activities, Physical Activities & MORE!
Participant

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
MaleFemale
Home Address

Street Address

Apt/Unit #

CityState

Zip Code
Guardian's E-mail
Enter E-mail Here
Phone Number
Enter Phone Number Here

Medical Information
Does the participant have allergies?
YesNo
COVID-19 precautions will be in place

Mask are required at all times!
Is the participant currently taking any medication?

Emergency Contact Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relation to participant
Should be Empty: