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2. 
4. 2022-23 School's Out/Afterschool Reduced Fees Application

   This form is for Afterschool and School's Out programs only. For all other programs, use the Share The Fun grant application.

   ALL families, regardless of income level, are eligible for the sliding fee scale funded by the City of Missoula, Missoula County and community donations. Please complete this form BEFORE REGISTRATION so that we may attach the correct discount level to your Webtrac account. Income levels and fees are listed below.

   ☀ If you received the 2021-22 Afterschool/School's Out Scholarship, there is no need to reapply; passes have been automatically renewed for this year. (Green, Purple or Orange level.)  Check which discount level is applied to your account.

   Valid for Afterschool and School's Out programs, 2022-23 school year only.

   HOW TO REGISTER
   Registration opens Tuesday, August 9, at 12 pm. After completing this form, we will email information about how to register for programs within 2 business days. Information provided will remain confidential. Questions or concerns? Use the comment box below, call 406-721-7275, or email parksrec@ci.missoula.mt.us. Sliding fees available through 6/09/23.

   LOWELL STUDENTS
   Lowell Neighborhood Center provides Afterschool and School's Out childcare via a separate program. There is no need to complete this form. Please email youthprograms@ci.missoula.mt.us for more information.

   SHARE THE FUN!
   Donate any amount to support recreation and aquatics grants for families who need financial assistance. Your contribution allows us to serve more Missoula families. Or check out the Parks and Recreation license plate—100% of proceeds fund recreation and aquatics grants. Thank you!

6. PARENT OR GUARDIAN First Name*
7. PARENT OR GUARDIAN Last Name*
9. Street Address*
10. Email*
12. City*
13. State*
14. Zip*
15. Phone*
17. Residency*

    1. Inside City limits
    2. In Missoula County, outside City limits
    3. Outside Missoula County
18. Do you know your Webtrac online registration login and password?*

    1. Yes.
    2. No, please send.
19. School my child/children attend:
    -- Select One --Chief CharloFranklinHawthorneJeannette RankinLewis and ClarkLowellPaxsonRattlesnakeRussellOther
21. Please list participant names and birthdates
    Members of your household only, please. List additional children in the box below.
23. Participant Name*
24. Birthdate*
    mm/dd/yy
26. Participant Name
27. Birthdate
29. Participant Name
30. Birthdate
32. Participant Name
33. Birthdate
35. Additional children in household
    First and last names, birthdates
36. Based on the income chart below, my family qualifies for:*

    1. Green Scholarship
    2. Purple Scholarship
    3. Orange Scholarship

    Proof of income not required. If you require additional assistance to meet your child care needs, please contact us at 406-552-6726 or email parksrec@ci.missoula.mt.us. No child will be turned away due to inability to pay.

38. 
40. Comments, Questions, Concerns?
42. Signature*

    By electronically signing this form, I certify the above information is accurate, and I agree my child/children will comply with program COVID-19 safety protocols as needed.

44. Learn more about School's Out/Afterschool Programs
    School's Out/Afterschool Programs Info Sheet
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field