Woodburn Aquatic Center

If you need financial assistance, we are here to help! Feel free to fill out an online application for assistance below. If you’d prefer to print out the form and submit in person with a copy of your 1040, Download & print it here. If you need assistant, please don’t hesitate to contact us and we can even mail one to you.

This scholarship form is for assistance with Aquatic Center related activities/memberships. Scholarship forms for other recreational programs or for the After School Club can be picked up at City Hall (270 Montgomery St.) or at the Aquatic Center.

Application for Financial Assistance

all required fields marked with *

General Information

Participant Information

Participant Family Information

Applicant/Participant Qualifies for Federal Free or Reduced Lunch Program
Applicant/Participant Qualifies for Oregon Health Plan

Digital Signature

Participant / Parent / Guardian Signature:
I am signing my name that all of the above information is true and correct*

I have read and agree the with the †Privacy Policy*

Please use number answers only