Maui Family YMCA

Maui Family YMCA Application For Financial Assistance

Please FILL OUT ALL information on this Financial Assistance (FA) application and ATTACH the required documents (by scanning or taking a picture and using the File Upload tool at the end of this application). Failure to complete application and provide required documents will delay or deny application review. PLEASE ALLOW A MINIMUM OF Three WEEKS FOR THIS APPLICATION TO BE PROCESSED (APPROVED OR DISAPPROVED) BY THE YMCA. Fees must be paid at the time of registration, after receiving your award letter and prior to the program start date. Please complete each section as best and fully as possible when filling out application.

APPLICANT INFORMATION

If applying for yourself please enter your information below. If applying on behalf of a child or multiple children, please enter the full name of each child in the name box below.

Participant ‘s/Applicant’s Full Name *

Participant ‘s/Applicant’s Date of Birth *

Participant ‘s/Applicant’s Gender *

Participant ‘s/Applicant’s Ethnicity

Home/Mailing Street Address *

City *

State/Province/Region *

Zip/Postal Code *

Country *

Phone Number *

Email Address *

Please select Membership Type you are applying for: *

Please choose any Y Programs you wish to apply for: (Please select all that apply)

Day Camps (Spring, Summer, Fall, Winter)

Group Swim Lessons

Swim Club

Martial Arts

Parkinson's Fitness

Personal Training

I am not interested in any Y Programs at this time