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Parks & Recreation Spring Break/Afterschool Scholarship March 15 to June 11

2. 

4. School's Out/Afterschool Program Scholarship
   This form is for those who have NOT previously submitted a Base Camp Scholarship form. ALL families, regardless of income level, are eligible for the Scholarship, funded by the City of Missoula. Please complete this form BEFORE REGISTRATION so that we may attach the correct scholarship level to your Webtrac account. *If you have already completed this form once, there is no need to reapply.

   This form is for those who have NOT previously submitted a Base Camp Scholarship form. ALL families, regardless of income level, are eligible for the Scholarship, funded by the City of Missoula. Please complete this form BEFORE REGISTRATION so that we may attach the correct scholarship level to your Webtrac account. *If you have already completed this form once, there is no need to reapply.

6. After completing this form, you will receive emailed information about how to register for School's Out/Afterschool programs within 2 business days. Information provided will remain confidential. Questions or concerns? Use the box below, call 721-7275, or email parksrec@ci.missoula.mt.us. Scholarship funds are available through 6/11/21.

   After completing this form, you will receive emailed information about how to register for School's Out/Afterschool programs within 2 business days. Information provided will remain confidential. Questions or concerns? Use the box below, call 721-7275, or email parksrec@ci.missoula.mt.us. Scholarship funds are available through 6/11/21.

8. PARENT OR GUARDIAN First Name*

9. PARENT OR GUARDIAN Last Name*

11. Street Address*

12. Email*

14. City*

15. State*

16. Zip*

17. Phone*

19. Residency*

    1. Inside City limits
    2. In Missoula County, outside City limits
    3. Outside Missoula County

20. Do you know your Webtrac online registration login and password?*

    1. Yes.
    2. No, please send.

21. School my child/children attend:
    -- Select One --Chief CharloFranklinHawthorneJeannette RankinLewis and ClarkLowellPaxsonRattlesnakeRussellOther

23. Please list participant names and birthdates
    Members of your household only, please. List additional children in the box below.

    Members of your household only, please. List additional children in the box below.

25. Participant Name*

26. Birthdate*
    mm/dd/yy

28. Participant Name

29. Birthdate

31. Participant Name

32. Birthdate

34. Participant Name

35. Birthdate

37. Additional children in household

    First and last names, birthdates

38. 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 552-6726 or email parksrec@ci.missoula.mt.us. No child will be turned away due to inability to pay.

40. 

42. Comments, Questions, Concerns?

44. 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.

46. Learn more about School's Out/Afterschool Programs
    School's Out/Afterschool Programs Info Sheet

47. COVID-19 Safety Protocols
    Learn more

Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field