Child's Full Name

Parent(s) Name

Phone

School

Grade

Age

Address

City

State

Zip

Email

Scholarship Information

1. Are there any special circumstances in your family that have resulted in your need for financial assistance (loss of job, illnesses, etc.)?

2. How long have you attended Bedford Acres?

3. How much will you be able to pay for this ministry?

4. Are you involved in any other ministries at Bedford Acres?