LAC Financial Assistance Application

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Application to reduce or defer membership dues during financial hardship.

Email *

To apply for Financial Assistance, a Parent or Legal Guardian must submit this application. Be prepared to supply supporting documentation of hardship such as Application for unemployment benefits, furlough documentation, release/notification paperwork from employer, etc. The request will be considered by a sub-committee of the Board of Directors within 2 weeks of submittal. You will be notified of the decision by the Operations Manager. Re-application will be required for further consideration after terms of assistance have expired. *

I Understand

Required

Enter your first and last name: *

Enter your swimmer(s) names and roster groups: *

What is your current address? *

What is best daytime contact phone number? *

How many years have your swimmer(s) been active in swimming? *

Less than 1 year

1-2 years

2-5 years

5 or more years

How many years have your swimmer(s) been active in swimming with LAC? *

Less than 1 year

1-2 years

2-5 years

5 or more years

What type of assistance are you requesting? *

Membership dues deferral or reduced fees

Past due balance forgiveness

Service hours forgiveness or reduction

Required

Are you willing and/or able to offset reduced dues with more volunteer hours? *

Yes

Maybe

Describe in detail the hardship that has caused this request for financial assistance (please email supporting documentation to michelle.johnson@swimlac.org): *

Please include any additional information here.

A copy of your responses will be emailed to the address you provided.

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