Application | Baileys Place

Prom Dress Assistance Program Application Form

Please attach a picture of yourself with your application.

Applicant Information

Gender

Male

Female

Parent/Guardian Information

Briefly describe your family’s financial situation and why you need assistance with obtaining prom attire

Have you attended prom before?

Yes

When is prom?

Is there any other information you would like us to consider when reviewing your application? (Optional)

Do you have any special needs or requirements that we should be aware of? If yes please explain your special needs or requirements.

What size dress or suit do you wear?

By submitting this application, I certify that the information provided is true and accurate to the best of my knowledge. I understand that the selection process is based on financial need and other relevant factors, and that submitting an application does not guarantee assistance. I consent to the use of my personal information for the purpose of this program.

Applicant Signature

Select a date

Guardian Signature:

Select a date

I hereby grant Bailey’s Place permission to use my likeness in photographs, video recordings, or digital images for use in any promotional materials, websites, or social media platforms. I understand that my image may be edited, copied, exhibited, published, or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video. I release Bailey’s Place from any and all claims, demands, or causes of action that I may have now or in the future arising out of or related to the use of my likeness. I acknowledge that I am 18 years of age or older and have read and understood the terms of this release.

Applicant Signature

Select a date

Guardian Signature:

Select a date

Please attach a picture of yourself with your application

Upload File

Upload supported file (Max 15MB)

Thank you! We’ll be in touch.