Swim for All Financial Assistance Inquiry

Financial Assistance Inquiry

Swim For All

This is a form for parents/guardians to inquire about receiving available financial assistance for Swim Lessons.

"*" indicates required fields

Parent/Guardian Name*

First Last

Address*

Street Address City State ZIP / Postal Code

Phone*

Email*

Enter Email Confirm Email

Marital Status*

Married

Single

Divorced/Widow

Total Annual Household Income*

Has your family participated in HEParks programs in the past?*

Child's Name*

First Last

Date of Birth*

Relationship to Parent/Guardian*

Child's School*

Child's Grade*

Child's Gender*

Has the child participated in swim lessons before? *Note that this program is intended for beginner level swim and safety instruction.*

Does this child require ADA accommodations or modifications for program participation?*

Do you want to include another child in the application?

2nd Child's Name

First Last

2nd Child's Date of Birth

2nd Child's Relationship to Parent/Guardian

2nd Child's School

2nd Child's Grade

2nd Child's Gender

Has the 2nd child participated in swim lessons before?

Does this 2nd child require ADA accommodations or modifications for program participation?

What is the best day of the week for your family to participate in swim lessons?*

Select all that apply

Is there a day that your child/family CANNOT participate?*

Select all that apply

Please attach one of the following additional documents:*

Max. file size: 128 MB.

• Letter confirming family SNAP benefits • Letter confirming Medicaid or AllKids coverage • Letter confirming your child receives free hot lunch at school

Hoffman Estates Park District | Hoffman Estates, IL

HEParks

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Programs

Sports

Preschool and Care

School Aged Care

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Figure Skating

Ice Schedules

Financial Assistance Inquiry

Swim For All

Programs & Sports

Parks & Facilities

Child Care

Ice Programs

Hoffman Estates Park District | Hoffman Estates, IL

HEParks

Park Board

Become Involved

Registration

Programs

Sports

Preschool and Care

School Aged Care

Camp

Hockey

Figure Skating

Ice Schedules

Financial Assistance Inquiry

Swim For All

Programs & Sports

Parks & Facilities

Child Care

Ice Programs

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