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Harper's Warriors Nomination Application
This application is to nominate a child with medical needs to be a recipient of the Harper’s Warriors softball tournament fundraiser. Please read each question carefully and answer completely.
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1.
Nominee’s name and date of birth:
(Required.)
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2.
Address of nominee:
(Required.)
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3.
Parent(s)’ name(s) and contact info:
(Required.)
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4.
Sibling(s) name(s)-
(Required.)
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5.
Number in household-
(Required.)
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6.
Diagnosis/Medical needs-
(Required.)
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7.
In the past 6 months have you received any financial support locally? (Note: your answer will not disqualify your application.) If you answered yes, please share what you have received.
(Required.)
No
Please select yes below and specify.
Yes
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8.
Are there any needs that are not covered by health insurance? If yes, please tell us those needs.
(Required.)
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9.
Tell us about the nominee.
(Required.)