Individual Registration Fee Sponsorship Application

Player Information

Name of Player:            Age:

Street Address:    City: Zip:     Years at PHMHA: 

Have you applied in the past for a sponsorship? Select one Yes No  

Parent and Guardian Information:(Note if deceased. Also, identify any non-parent guardian).

Father's Name:    Address:

Mother's Name:    Address:

Income Information

Father's Employer:    Position:

Annual Income:    Length of Current Employment (years):

Mother's Employer:    Position:

Annual Income:    Length of Current Employment (years):

Other Sources of Income:

Total Income from other sources:

Miscellaneous Information

Identify any fundraising efforts or volunteer efforts you have or are engaging in for PHMHA:

Please provide any additional information you would like the Sponsorship Committee to be aware in considering your applicaiton:

Name of Applicant:    Phone Number:

BY SUBMITTING YOU AGREE THE ABOVE INFORMATION IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE: