First 5 and Premier Aquatics Scholarship Program Application

First 5 and Premier Aquatics Scholarship Program Application

If you have multiple children who qualify, please submit one form per child.
Parent Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
City*
Zip Code*
Child's Name*

First NameLast Name
Child's Birthdate*

MonthDayYear
Date
EnglishSpanishKoreanVietnameseMandarinCantoneseTagalogArabicOther
Hispanic or LatinoAmerican Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhitePrefer not to sayOther
To qualify for this scholarship you must meet one or more of the eligibiity criteria below:
- Children served by a First 5 Riverside County funded agency.
- Children who have experienced a near drowning or who are at a greater risk for drowning (ex. Child lives near an open body of water).
- Children of families eligible for public assistance including but not limited to:
  - CalWorks
  - CalFresh
  - Medi-Cal
  - WIC
  - Quality Start Riverside County CAPP/RHAP
Other Criteria as approved by First 5 Riverside County that define eligibility
Participating children must be at least six months old to enroll.

Priority enrollment will be given to children that are at high risk for drowning: those living in a home with access to a pool, have a family member with a pool, infants/toddlers, children who have experienced near drowning and children involved in the child welfare system.
Lives near body of waterQualifies for or currently receives public assistanceServed by First 5 Riverside County funded agencyExperienced a near drowningInvolved in the child welfare system
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