Mermaid Pool Pass - Return App — Plus One Foundation

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Renewing 'Mermaid' Grant - Online Application

*Only for individuals who have already received a pool pass grant

Name *

Name

First Name

Last Name

Phone *

Phone

(###)

###

####

Email Address *

Has your contact information changed since your last application? *

Yes

Which pool are you requesting a pass for? *

How often do you currently swim or plan to swim? *

Do you have the financial means to pay for this experience? *

Yes

Please describe in detail any progress or positive affects you have experienced as a result of being granted a pool pass in the past. Be as specific as possible. *

Is the applicant over the age of 18 years old? *

Yes

If the applicant is UNDER 18, please write the full name of Guardian and their contact info below.

Please check all that apply: *

Plus One may use my first name and a quote for publicity purposes.

I verify I am NOT the immediate family member of a Plus One Board of Director.

I hereby certify that the information on this form in its entirety is true and correct to the best of my knowledge.