Roger Kids Fund Application – New York Rabbit & Cavy Breeders Association

Roger Kids Fund Grant Applications MUST be received by September 1st

Youth Applicant's Name:

First

Middle

Last

Youth Applicant's Address

Address Line 1

Address Line 2

City

State

Zip Code

Youth Applicant's Phone

Youth Applicant's Date of Birth

Youth Applicant's Email

REQUIREMENTS FOR RECEIVING A GRANT

A. The recipient must have been a member of a NYRCBA All Breed Club for at least one (1) year prior to submitting an application. I am a member of the following All Breed Club:

Name of All Breed Club

B. All applicants must have parental permission to attend the ARBA national Convention AND submit proof of adult supervision during the ARBA National Convention.

Parent/Guardian #1 Name:

First

Middle

Last

(required)

Parent/Guardian #1 Daytime Phone:

(required)

Parent/Guardian #1 Email:

(required)

Parent/Guardian #2 Name: (optional)

First

Middle

Last

(optional)

Parent/Guardian #2 Daytime Phone:

(optional)

Parent/Guardian #2 Email:

(optional)

I, being the parent and/or legal guardian of the child named above, do hereby attest that my child has my permission to attend the ARBA National Convention in the year:

Required

C. All YOUTH applying for such financial assistance must meet the following criteria and CERTIFY that:

1. I have been active for a minimum of one (1) year in a NYRCBA All Breed Club

Yes
No

Name of All Breed Club

2. I have participated in one (1) NYRCBA sponsored Youth Event/Activity 12 (twelve) months prior to submitting this request for funding

Yes
No

List NYRCBA Youth Event/Activity:

3. Youth shall also have shown/exhibited rabbits/cavies in at least five (5) NYRCBA All Breed shows in the year requesting said funding. List 5 shows here:

4. Youth shall be 18 years of age or under.

I certify that I am 18 years of age or under

5. Youth shall have parental/guardian permission and certification on their plans to attend and be accompanied to an ARBA Convention in such year and to make a request for said financial aid.

I attest that my Parent/Guardian has completed the required permissions & certifications

YOUTH APPLICANT CERTIFICATION:

Date:

PARENT/GUARDIAN #1 CERTIFICATION: (required)

Date:

PARENT/GUARDIAN #2 CERTIFICATION: (optional)

Date

Additional Documentation:

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