Leisure Access Program Participant Application

Eligibility

The Leisure Access Program (LAP) provides an opportunity for individuals with limited income to participate in recreational activities.

In order to qualify, the applicant(s) must be a permanent resident who lives within the City of Prince George municipal boundaries and meets one of the two categories below:

Have an annual family income in the previous/current year that is below the Statistics Canada Low Income Guidelines (Refer to Low Income Cut-Offs before Tax Table). An official Revenue Canada document for each adult in the household, clearly stating your income (Line 150 on tax assessment) is required.
Receive a BC Seniors Supplement that is below the Statistics Canada Low Income Guidelines. A photocopy of your BC Seniors Supplement is required.

Low Income Cut-Offs before Tax Table

# In Household	1	2	3	4	5	6
Income Under	$27,252	$38,682	$47,375	$54,704	$61,161	$66,998

Remember to bring copies of this documentation when you visit the pool with your completed application. None of this documentation will be copied- only verification is required.

Participant Information

Full Name

Phone

Address

Postal Code

Date of Birth

Additional Household Family Members

Full Name	Date of Birth	Operations
Full Name	Date of Birth

Use the button above to add additional family members

Application Checklist

Complete this Application Form
Bring either Revenue Canada Documentation or a BC Seniors Supplement Statement to the pool for verification
All family members requesting access to the program are listed above

Agreement

The personal information on this form is collected by the City of Prince George for the purpose of registration in the Leisure Access Program and communication about the program, under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of information, please contact the Manager, Aquatics or Supervisor, Civic Initiatives and Partnerships at 1100 Patricia Boulevard, Prince George, BC, by telephone (250-561-7600 or 311), or email leisureaccessprogram@princegeorge.ca.

I agree to and acknowledge all the terms of this application