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2. Youth Scholarship Application
6. Parent/Guardian Name*
7. Email Address
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
17. Participant's Name*
18. Activities (choose all that you're signing your child up for):*

    1. Therapeutic Recreation
20. Qualification for Scholarship (check all that apply):*

    1. Recipients of Current Free and Reduced Lunch Program (income level under $)
    2. Recipients of SSI (Supplemental Security Income) or Social Security Benefits
    3. Recipients of Medical Assistance Program
22. Please upload proof of qualification (photo of insurance card, free and reduced lunch letter, etc).
24. Any program over $75.00 will be set at 50% of the program fee. Programs not included in the Scholarship Program include: Private Swimming Lessons, River Springs Water Park Season Pass, River Springs Coupons Booklets, Trips, Association Programs and Association Camps. WSI & Lifeguard – limit 4 participants per year at 50% of program cost. Limited quantities of equipment may be checked out – ask staff for availability.
26. Acknowledgment of Correct Information: I acknowledge the information contained on this application is accurate and correct. I hereby give permission to the Owatonna Parks and Recreation Department to verify this information. I understand if any information on this application is found to be incorrect, my privilege of applying for scholarship money is revoked. The Owatonna Parks and Recreation Department reserves the right to verify all information contained on this application. Please type name for acknowledgement:*
28. Acknowledgement for Release of Information: The information requested at the time of registration form will be used to verify eligibility, determine staff, facility, and equipment needs. You/your child’s name, age, grade level, address, telephone number, and health information will be provided to city staff, volunteers, the city attorney, insurer and auditor. Although you are not legally required to disclose this information, failure to do so will prevent you/your child from participating in this program. Please type name for acknowledgement:*
29. Date:*
    Date:
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field