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* 1. Athlete's First Name

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* 2. Athlete's Last Name

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* 3. Athlete's Date of Birth

Date

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* 4. Address

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* 5. Athlete's Gender

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* 6. Ethicity

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* 7. What youth soccer team, league or club is your athlete interested in joining? (If your application is approved for assistance, the payment will be mailed directly to the team, league or club in benefit of your athlete)

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* 8. When does the team's season begin?

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* 9. Please upload the team's flyer, if available

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 10. Do you currently receive any of the following assistance?

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* 11. What is your household’s monthly gross income?
(Proof of income must be submitted below to complete your application)

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* 12. Proof of Income (Last 4 weeks)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 13. By signing this form, I hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability and cancellation of any current and future assistance opportunities from KickStart Soccer Fund, Inc. (Parent/guardian please type your name below)

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