Name: _________________________________________________________________________________ Address: _____________________________________________ Phone: (_____) _______ ___________ City: ___________________________________________ State: ________ Zip: ________________ Parent/Guardian Name: ___________________________________________________________________ Grade: _______ School: _____________________ E-mail: ___________________________________ DOB: _________________________ Age: ___________ Gender (Circle One): F M Please check the box if the answer to the following questions is yes : Do you require federal assistance for housing? Do you use WIC? Does your household use food stamps? Annual Household Income: $ ____________________ Use this space for any additional information, if necessary. By signing, the above information is true and correct . Student Signature ________________________________________ Parent Signature _________________________________________ (If under 18 years of age) Sioux Falls Jazz and Blues JazzFest Jazz Camp 2017 Scholarship Application (Please use black ink and print clearly) We want you to go camping! Together we can make this happen. Completing this form is your first step toward ensuring that you will be joining us for the best week of your life. Plase answer accurately, and someone will be in touch. If you have questions, contact Sioux Falls Jazz & Blues at 605.335.6101. 2017 JAZZ CAMP SCHOLARHIP APPLICATION