2025-2026 OUTREACH CHAMPS FEE APPLICATION

Outreach members are eligible for reduced championship fees. The total champs fee will be $10.
Requirements:
1. Athlete must be a registered outreach athlete in good standing.
2. Applications shall include a copy of the athlete’s qualifying documents for Outreach Membership.
3. Applications will be approved by the LSC registrar.

Qualifying documentation:
1. LIEAP: Low Income Energy Assistance Program
2. Medicaid
3. Kids Care CHIP
4. Free and Reduced federal lunch program
5. Foster care program
6. Special circumstances (approved on a case by case basis by the Diversity, Equity, and
Inclusion Committee).

Swimmer Name*

First NameLast Name

Club Team*

Upload outreach documentation (from list above):*

If you are not the person named on the documentation, by uploading you are stating you have received permission to share their personal data.

Name of Person Submitting this form:*

First NameLast Name

Contact Phone:*

Please enter a valid phone number.

Contact Email*

example@example.com

Relationship to Athlete:*