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BROTHER MARTIN HIGH SCHOOL SPORTS ACTIVITIES AGREEMENT DATE: ___ THIS STUDENT HAS DOCTORS AUTHORIZATION TO PARTICIPATES: ___ NO: ___NAME OF STUDENT:___ 8th 9th 10th 11th 12th (Circle One) ADDRESS

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Individuals with hearing impairments who may benefit from cochlear implants or related services.

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Family members or caregivers of individuals with hearing impairments who are seeking financial assistance or support for cochlear-related expenses.

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Form benefits of cochlear is a form used to apply for financial assistance for cochlear implants and related services.

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Individuals who need financial assistance for cochlear implants and related services are required to file form benefits of cochlear.

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