Fee Appeal Form
Family Information
Tennis Success Family Number
*
Parent/Guardian Name
*
First Name
Last Name
Participant(s) name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Current Enrollment
Program
*
After School 10 and Under
After School 11 and Up
After School Elite and Jr.Elite/Tournament Players
Summer Camp: 10 and Under
Summer Camp: 11 and Up
Summer Camp: Elite and Jr. Elite/Tournament Players
Other
School
*
Date of Registration
*
What was the weekly fee that was assigned?
*
Free
$5.00
$10.00
$15.00
$20.00
$25.00
Why are you requesting an appeal? (Check all that apply.)
Household income was entered incorrectly.
Household size was entered incorrectly.
Required documents were not available during registration.
Income has recently changed.
Shared custody affects household income.
I believe my fee was calculated incorrectly.
Other (please explain)
Please explain why you believe your assigned fee should be reconsidered.
Has any of the following changed since registration?
*
Household Income
Household Size
Employment
Custody arrangement
Government assistant eligibility
None
Please attach any documents that support your appeal. Examples: Updated pay stubs, W-2, Tax Return, Employer letter, Court custody documents (if applicable), Government assistance documentation, etc.
*
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I certify that the information provided is true and complete to the best of my knowledge. I understand that Tennis Success may request additional documentation before making a decision.
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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