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2. Applicant Name*
4. Address*
5. City, State, ZIP*
7. Primary Phone Number*
8. Secondary Phone Number
9. Email Address*
11. LIST EVERYONE IN YOUR HOUSEHOLD THAT YOU WOULD LIKE TO RECEIVE BENEFITS

    PLEASE REMEMBER TO LIST YOURSELF

    Household is defined as the immediate “parent-child” family unity, including only the parent(s) or legal guardians(s) and their children by birth, marriage, adoption, or foster that live together in the same household. No more than two adults per household.

13. First and Last Name*
14. Relationship to Applicant*
15. Date of Birth*
    Date of Birth
17. Do you need to add an additional child?*

    1. Yes

    1. No
19. First and Last Name*
20. Relationship to Applicant*
21. Date of Birth*
    Date of Birth
23. Do you need to add an additional child?*

    1. Yes

    1. No
25. First and Last Name*
26. Relationship to Applicant*
27. Date of Birth*
    Date of Birth
29. Do you need to add an additional child?*

    1. Yes

    1. No
31. First and Last Name*
32. Relationship to Applicant*
33. Date of Birth*
    Date of Birth
35. Do you need to add an additional child?*

    1. Yes

    1. No
37. First and Last Name*
38. Relationship to Applicant*
39. Date of Birth*
    Date of Birth
43. Required Documentation*

    Please include ONE of the following items:

    • Award letter for TANF (Temporary Assistance for Needy Families)
    • Award letter for SNAP (Supplemental Nutrition Assistance Program)
44. Upload Photo ID*

    Please upload photo id to be considered for the Fun for All Fund.

48. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    I hereby confirm that the information provided is true and accurate to the best of my knowledge. I understand that providing false information may result in the denial of financial assistance or the revocation of any assistance granted. City of Forest Grove Parks & Recreation reserves the right to revoke awarded financial assistance in the event of any misrepresentation or falsification of information. Failure to adhere to program/activity guidelines, or any other violation of City policies. The City also reserves the right to modify or terminate the Fun For All Fund program at its discretion.

    1. I agree.
50. Electronic Signature
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field