Horse Sense for Kids - Horse Sense Subsidy Program Application

Horse Sense Subsidy Program Application

The Horse Sense Subsidy Program (HSSP) is available to families whose financial circumstances make them unable to pay the full amount of Horse Sense for Kids (HSFK) programs. The HSSP program is supported through the generosity of donors, grants, fundraising and Delta Bingo. The goal of the HSSP is to make horsemanship more accessible regardless of a family’s ability to pay and HSFK encourages families who could use this assistance to apply. To allow us to accommodate as many requests as necessary, applicants must contribute as much as they are able. An application must be completed for EACH program and EACH child needing financial assistance. The HSSP committee will review applications and allocate funds according to needs and funds available.

To be eligible for a HSSP, applicants must:
• Submit a completed HSSP Application including proof of income
• Complete the Photo Release Form which allows participants to be photographed while attending HSFK programs (contact HSFK if you have an issue with the photo release)
• Complete the post-program survey provided by HSFK
• Commit to sending a thank you card or letter after the HSFK program. Our donors appreciate hearing how their donation helped a child participant in a HSFK horsemanship program.

I agree to compete the above requirements. *

Signature of Parent/Guardian*

Please sign your name inside the box

Type your name

Signature style

Signature of Parent/Guardian Signature pad

Date *

Child's Full Legal Name

First name *

Last name *

Gender * Please specify

Date of birth *

Important medical information *

Parent/Guardian Form

Relationship

First name *

Last name *

Email *

Mobile *

Address *

City *

Country *

State/Province *

Region *

Zip/Postal code *

Other phone (home or work) *

Number of children in household

Ages of children

Horse Sense Program you would like your child to attend (including dates):

Are you able to contribute financially to the costs of the program? *

Yes No x Clear

If yes, what amount are you able to contribute?

Financial Information

Please provide proof of income statement with application

Income statement *

Upload an imagine of your income statement

Gross household annual income from wages *

Gross household annual income from wages

Other income *

Other income

Total Annual Income *

Total Annual Income

Other expenses which contribute to your need for assistance *

Other expenses which contribute to your need for assistance

Have you applied for and been granted financial assistance from any other organization? *

Yes No x Clear

Please mention any special circumstances you would like considered and reasons for participation in a Horse Sense horsemanship program.

Signature of Parent/Guardian*

Please sign your name inside the box

Type your name

Signature style

Signature of Parent/Guardian Signature pad

Date *

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First name

Last name

Mobile

Participant

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Last name

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