Live Like Jake Foundation
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Live Like Jake Foundation
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Application for Scholarship

Live Like Jake Foundation, Inc. was created by Keri and Roarke Morrison in honor of their son, Jake Morrison, who passed away as the result of a tragic drowning accident. The Foundation’s mission is to promote childhood drowning awareness and water safety. In order to accomplish this, we encourage self-rescue swim lessons. We try to help minimize the cost of the lessons for those in financial need by granting scholarships. Please note these scholarships are for families that truly cannot afford the lessons.

ELIGIBILITY

  • Assistance is granted based on financial need. We consider household income and number of legal dependents as the primary criteria. While we understand that monthly expenses can be extensive, it is impossible to base scholarship awards on each individual budget.
  • We believe that a sense of ownership is developed if the participant contributes to the cost of his/her involvement. Therefore, scholarship recipients may pay a percentage of the program fees.
  • Scholarships are granted for one session for up to 6 weeks of lessons. Upon expiration, the recipient must reapply. The original scholarship application information is valid for 6 months after original approval.
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Parent or Legal Guardian Information

Parent-Legal Guardian Name(Required)
MM slash DD slash YYYY
Parent-Legal Guardian Email (all communication will go here)(Required)
Parent-Legal Guardian Address(Required)
Does a Spouse or Partner live with you?(Required)
Spouse-Partner Name(Required)
MM slash DD slash YYYY
Spouse-Partner Email(Required)
Do you own or rent your home?(Required)

Do you have a pool at your residence?
DROWNING IN THE FAMILY(Required)
*HAS YOUR CHILD EXPERIENCED A DROWNING, EITHER FATAL OR NON-FATAL (THAT REQUIRED AT LEAST ONE-NIGHT IN HOSPITAL) ? MUST BE YOUR CHILD; NOT A RELATIVE.
IF THE ANSWER IS YES, PLEASE INCLUDE DETAILS OF THE EVENT LIKE NAME OF CHILD, DATE OF EVENT, AGE OF CHILD, CIRCUMSTANCES OF THE DROWNING.

Legal Dependents

Email Legal Dependent Name Date of Birth Legal Dependent Gender Will Legal Dependent Receive Lessons? Legal Dependent New or Refresher Course?Actions
      
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Number of Legal Dependents(Required)
Name Dependent 1(Required)
MM slash DD slash YYYY
Gender - Dependent 1(Required)
Will Dependent 1 receive lessons?(Required)
New or Refresher Course?(Required)

Employment Information

Employment Status

Employers
Please list your employer's information.
Employer
Supervisor
Employer Phone
Length of employment
Position
Weekly Hours
 
Spouse-Partner Employment Status

Spouse-Partner Employers(Required)
Please list your souse-partner employer's information.
Employer
Supervisor
Employer Phone
Length of employment
Position
Weekly Hours
 
IMPORTANT: ENTER GROSS MONTHLY AMOUNT BEFORE TAXES HAVE BEEN TAKEN OUT. NOT YEARLY & NOT NET.
FILED TAXES LAST YEAR?(Required)

General Information

Ever received Scholarship from Live Like Jake?
Lessons Time Preference(Required)
Have you taken a vacation/trip in the last 6 months?(Required)
Are you planning a vacation|trip in the next 6 months?(Required)
Do you currently have annual passes to any theme park?(Required)
Have you applied for a scholarship with another non-profit?(Required)
HOW DID YOU HEAR ABOUT US?

ALREADY SPOKEN TO SWIM INSTRUCTOR?(Required)
PLEASE NOTE that instructor must know you are applying for scholarship.
If NO, please visit infantswim.com to ensure there is an ISR instructor in your area.

*** UPLOAD REQUIRED DOCUMENTS BY USING THE "Drop files here or Select Files button" BELOW FOR EACH.

*** APPLICATIONS WILL NOT BE PROCESSED UNTIL ALL REQUIRED DOCUMENTS ARE SUBMITTED ***

A copy of the following documents MUST be provided to process the application. (For security measures please black out your SSN on all documents):

  • Driver’s License
  • Two current pay stubs (an additional two from your spouse/partner if applicable)
  • Your most recent tax return (e.g. complete 1040 form, federal tax return, NOT your W2 form)
Do you have a valid Driver's License?(Required)

Upload your files in .pdf, .doc, .docx or .jpg format
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Accepted file types: pdf, doc, docx, jpg, Max. file size: 25 MB, Max. files: 10.
    Do you have 2 current pay stubs (an additional 2 from your spouse/partner if applicable)?(Required)

    Upload your files in .pdf, .doc, .docx or .jpg format
    Drop files here or
    Accepted file types: pdf, doc, docx, jpg, Max. file size: 25 MB, Max. files: 10.
      Do you have your most recent tax return (e.g. complete 1040 form, federal tax return, NOT your W2 form)?(Required)

      Upload your files in .pdf, .doc, .docx or .jpg format
      Drop files here or
      Accepted file types: pdf, doc, docx, jpg, Max. file size: 25 MB, Max. files: 10.
        IF APPLICABLE PLEASE INCLUDE:
        • A “Did Not File” taxes form - PROOF REQUIRED
        • Social Security benefits statement
        • Disability benefit statement
        • Unemployment benefit statement
        • Child Support statement
        Upload your files in .pdf, .doc, .docx or .jpg format
        Drop files here or
        Accepted file types: pdf, doc, docx, jpg, Max. file size: 25 MB, Max. files: 10.
          PLEASE READ THE FOLLOWING AND SIGN BELOW:(Required)

          MUST SCROLL TO THE END: I hereby certify that the information in this application is true, accurate and complete to the best of my knowledge. I am aware that it is my responsibility to notify Live Like Jake Foundation, Inc. in writing of any change in the information supplied on this application, as it may affect my eligibility for financial assistance. I understand that every part of this application must be completed and that I must provide adequate proof of income in order for my application to be processed. I understand that incomplete applications cannot be processed.

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          RELEASE OF LIABILITY AND INDEMNITY AGREEMENT(Required)

          MUST SCROLL TO THE END: I, on behalf of myself, my child, my heirs, executors, administrators, successors, and/or assigns, as a condition of receiving financial support from Live Like Jake Foundation, Inc. for my child to participate in self-rescue swim lessons, waive all claims for any personal injury, death, loss of health, financial loss or damage to property occurring during, or as the result of my child’s participation in self-rescue swim lessons. Furthermore, I indemnify, hold harmless and affirmatively release Live Like Jake Foundation, Inc., its program staff and their affiliates, principals, employees and/or agents for any such loss, damage, injury or liabilities. This release of liability includes any claims made against Live Like Jake Foundation, Inc. related to my child’s participation in self-rescue swim lessons with an independent instructor. I understand risks are associated with self-rescue swim lessons. I waive all claims against the Foundation as described above without limitation.

          “DID NOT FILE” TAXES FORM (IF APPLICABLE)

          I did not file a Federal tax return for the year because my income level (which excludes social security income) was below the Federal Filing requirements.

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          PERMISSION FOR CHILD'S NAME IN PHOTOS(Required)
          PLEASE INDICATE IF WE MAY IDENTIFY THEIR NAME OR NOT.
          DIGITAL RELEASE FORM FOR MINOR CHILDREN

          MUST SCROLL TO THE END: I, being the Parent/Legal Guardian, hereby consent to the use of images, depictions, and recordings notated below of the above named minor by Live Like Jake Foundation Inc. their assigns or successors at its sole discretion. I, with my signature below, acknowledge that such photographs, films, recordings and videos shall be the property of Live Like Jake Foundation, Inc. and they shall have the right to duplicate, reproduce, and make other uses of such media as notated below as they may desire free and clear of any claim whatsoever.

          • Photographs
          • Videotape
          • Digital images of my child for use in promotional or educational materials as follows:
          • Printed publications or materials
          • Electronic publications or presentations
          • Website (www.LiveLikeJake.com)
          • Facebook pages

          I authorize the use of these images indefinitely without compensation to me. All prints, digital reproductions and video recordings shall be the property of Live Like Jake Foundation, Inc.

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          SCHOLARSHIP GUIDELINES

          MUST SCROLL TO THE END: The ISR program requires a 10- minute daily lesson for 5 days a week for approximately 4 to 6 weeks (or until the instructor deems the child is safe). You have to commit to this schedule in order to accomplish the desired results and agree to abide by the instructor’s guidelines and rules. Excessive cancellation of lessons is not acceptable and could result in termination of scholarship.

          Please note that ISR has a $105 registration fee for new students and $35 fee for existing students. The foundation WILL reimburse this fee when the lessons have been completed and all the scholarship guidelines have been followed.

          You MUST update Live Like Jake weekly with the progress of the lessons. This will enable the Foundation to share our success stories, spread the word about drowning prevention, and encourage more parents to sign up their children for these lifesaving skills. Please note that if the above mentioned in red is not completed, the scholarship can be revoked and future refresher applications will not be approved.

          We also ask that you participate or volunteer (if local) in one of our fundraisers/events we hold throughout the year. We have several annual events that participation can be from anywhere. These events are how we raise the money necessary to help your family and others. Please visit our Facebook page and website for upcoming events.

          Please sign below if you agree to the terms of the scholarship.

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          Copyright ©2023 Live Like Jake Foundation | Site by Brent Thomas.
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          Welcome back,