New Submission

The Iowa City Parks and Recreation Department RecAssist Program helps support Iowa City residents by subsidize recreational programs and opportunities. All information is confidential and is not a matter of public record.

If eligible, RecAssist will reduce participant fees by 50% for most recreational programs, swim punch cards and passes, and 100% subsidy for swim lessons. This application must be completed once per calendar year; the discount is valid through December 31 of the year completed.

Once approved, RecAssist beneficiaries can enroll in programs throughout the year and receive the discount. RecAssist beneficiaries must make staff aware of their eligibility during registration process and can enroll on the phone or in person.

Program registrants must pay for discounted fees at the time of registration or purchase. RecAssist will be forfeited if your account becomes delinquent.
For further information call 319-356-5100

Applicant Information

Full Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Date of Birth*field type date
Address*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Do you need to provide parent/legal guardian information?*field type radio button
Do you need to provide parent/legal guardian information?YesNo

Parent/Legal Guardian Information

Full Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Address*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country

Daytime Phone*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Home/Cell Phone*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email*field type email
Please list other individuals in household that should be listed on the account and eligible for RecAssist discount
Namefield type single line Date of Birthfield type date
Row 1× Namefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Date of Birthfield type date
×
Add

	Namefield type single line	Date of Birthfield type date
Row 1×	Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Date of Birthfield type date	×

Statement of Eligibility

To be completed in full by student's parent or legal guardian or counselor.
The RecAssist program is limited to Iowa City residents - persons living inside the city limits of Iowa City.
I am enrolled in the City of Iowa City’s Utility Discount Program*field type radio button
I am enrolled in the City of Iowa City’s Utility Discount ProgramYesNo
I declare that there are ___ persons in my household.*field type single line
Input blocked. Maximum character limit of 2 characters reached.
The member/s that are being registered for activities are recipient/s of Title XIX benefits.*field type radio button
The member/s that are being registered for activities are recipient/s of Title XIX benefits.YesNo
At least one member of my household is enrolled in the following programs (check all that apply)?field type checkbox
At least one member of my household is enrolled in the following programs (check all that apply)?Supplemental Security Income (SSI)Social Security Disability Insurance (SSDI)Family Investment Program (FIT)Title XX Childcare AssistanceElderly Tax Credit on real estate tax or State Rent disbursement
I declare that the combined gross income (earned and unearned) of all persons living in my household is $________*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
per*field type radio button
perWeekMonthYear
3. I am aware that my application may be selected on a sample basis for verification. Should my application be selected, I will cooperate fully in the verification.
4. I understand that services received under this program are not to be sold or exchanged.
5. I declare that I am a resident of Iowa City.
I (the applicant or guardian) verify that I have completed the above information and that all the information is true.
Applicant / Guardian Signature*field type signature
Applicant / Guardian Printed Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Submission Datefield type date
Date will be captured on form submission

Iowa City Parks and Recreation

Applicant Information

Please list other individuals in household that should be listed on the account and eligible for RecAssist discount

Statement of Eligibility