Financial Assistance Application

Financial Assistance Application

2025-2026
Los Gatos-Saratoga Department of Community Education & Recreation (LGS Recreation) is committed to making Clubhouse Programs accessible to everyone. Financial Assistance may be available for families who otherwise would not be able to participate.

Eligibility
- Participant resides in service area
- Household income falls on or below the “Home Income Limits” according to the U.S. Department of Housing and Urban Development guidelines
How to Apply
1. Review Financial Assistance Application
2. Please provide verification of income (e.g, Form 1099 or W2) for current tax year for all working members of the household.
3. Submit this application and documents
Process
- Once completed application and documentation has been received, there is a brief processing period.
- Applications will be reviewed on a first come, first served basis. As funds are limited, the remainder of qualified applicants will be placed on a finacial assistance waiting list.
- After a thorough review of the application and documentation, LGS Recreation will notify applicant electronically and apply awarded discount percentage in the system. LGS Recreation reserves the right to refuse assistance to any applicant.
- Eligibility for assistance will be reviewed annually or as deemed necessary.
- LGS Recreation understands the importance of maintaining our participants personal information and will destroy all documentation prior to its disposal.
Note: LGS Recreation is not responsible for returning any documentation that accompanies the application. Please ensure that you have kept all your original documents.

Parent/Guardian (1) Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Employer*
Occupation*

Parent/Guardian (2) Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Same Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Employer
Occupation

Child Information (Please provide names of all children to be considered for a scholarship)

	Last Name	First Name	Date of Birth	School Attneding	Grade
Child 1
Child 2
Child 3

Program Interest (Please check off all programs you are request assistance for)*

Blossom Hill ClubhouseDaves Ave ClubhouseLexington ClubhouseVan Meter ClubhouseFisher Middle SchoolClubhouse Camps

Child Care Needs (Please indicate your tuition days) *

	Monday	Tuesday	Wednesday	Thursday	Friday
Before School Care
Kinder Care (Until 3:00pm)
Kinder Care (Until 5:00pm)
After School Care (Grades 1-5)
Extended Care 5:00pm-6:00pm (Grades K-5)

Income Information

Names of all individuals living in the household
Number of Income earners in our household*

Individual 1
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Monthly Income*
Verification of income (e.g, Form 1099 or W2)*

Cancelof

Individual 2
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Monthly Income*
Verification of income (e.g, Form 1099 or W2)*

Cancelof

Individual 3
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Monthly Income*
Verification of income (e.g, Form 1099 or W2)*

Cancelof

Individual 4
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Monthly Income*
Verification of income (e.g, Form 1099 or W2)*

Cancelof

Individual 5
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Monthly Income*
Verification of income (e.g, Form 1099 or W2)*

Cancelof

Individual 6
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Monthly Income*
Verification of income (e.g, Form 1099 or W2)*

Cancelof

Individual 7
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Monthly Income*
Verification of income (e.g, Form 1099 or W2)*

Cancelof

Signature
I certify that all information is valid and complete and hereby authorize LGS Recreation to request and/or verify any of the above information as deemed necessary. If awarded a scholarship, I understand I am still subject to the rules and regulations of LGS Recreation. I also understand LGS Recreation’s scholarship fund can be terminated at any time.
Parent/Guardian (1) *

Clear
Parent/Guardian (2)

Clear
Should be Empty:

Financial Assistance Application

Income Information