Essex Baseball/Softball Fund, Inc. in memory of Neil Rivers, Jr. 10915 Red Lion Road, White Marsh, MD 21162
	APPLICATION FOR ASSISTANCE
Child name:
Address:
City/State/Zip
Home Phone
D/Birth:
Father Name:
Cell phone:
Mother Name:
Cell phone:
Requesting:	Help with Registration         Yes                 No
(circle)	Help with cost of uniform     Yes                No
	Help with cost of spikes       Yes                No
	Other:  Please explain
Reason:	State in your own words why you feel you need
	assistance from the Essex Baseball/Softball
	Fund.  Please be specific and detailed.