Student Registration & Swim Scholarship
Fields marked with an * are required
Must be completed by a parent or guardian.
Florida Drowning Prevention Foundation is providing Basic Survival Swimming Lessons for your child in the hope we can prevent another drowning death. Thank you for taking this important first step in saving a life.
In what county do you reside?
*
Please Select
Alachua
Baker
Bay
Bradford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clay
Collier
Columbia
DeSoto
Dixie
Duval
Escambia
Flagler
Franklin
Gadsden
Gilchrist
Glades
Gulf
Hamilton
Hardee
Hendry
Hernando
Highlands
Hillsborough
Holmes
Indian River
Jackson
Jefferson
Lafayette
Lake
Lee
Leon
Levy
Liberty
Madison
Manatee
Marion
Martin
Miami-Dade
Monroe
Nassau
Okaloosa
Okeechobee
Orange
Osceola
Palm Beach
Pasco
Pinellas
Polk
Putnam
St. Johns
St. Lucie
Santa Rosa
Sarasota
Seminole
Sumter
Suwannee
Taylor
Union
Volusia
Wakulla
Walton
Washington
Confirm county
County is correct
Do you have a child with a diagnosed disability?
*
Yes
No
What is the disability?
Parent/Guardian Name
*
First Name
Last Name
Relationship to Student
*
Student Name
*
First Name
Last Name
Student Date of Birth
*
-
Month
-
Day
Year
Date
Student Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
*
example@example.com
Do you have a preferred swim school?
Is the student afraid of water?
*
Yes
No
Is there a pool at home?
*
Yes
No
Have you previously applied for a scholarship?
*
Yes
No
How did you hear about FLDPF?
*
Social Media
Online Search
Referral
Other
Are you requesting a scholarship for:
*
Yourself
Your Child or Children
A Family Member
How many children are in the household?
*
Ages of Children
*
Separate different ages with a comma
Do you receive any of the following State of Florida benefits?
Florida Medicaid
Florida Food Assistance Program
Free School Breakfast/Lunch
WIC
Section 8 Housing
Florida Summer Food Service
Florida Head Start
Florida Special Milk Program
Other
Annual household income level?
*
$5,000-$25,000
$25,001-$30,000
$30,001-40,000
Over $40,000
Submit
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Due to increased demand we are only accepting a certain number of applications in Collier and Lee county and children with Autism. We hope to have scholarships open up to the rest of the state soon.
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