THIS APPLICATION MUST BE RENEWED EVERY 12 MONTHS.
I certify that the above information is true and complete to the best of my knowledge, and that I do not have additional income not represented above. I agree, if necessary, to send additional information and documentation to support the above statements. I understand that flexible pricing is based on need. In the event that I or my children must cancel our participation, I will contact the YMCA immediately so that this benefit may be provided to others. I understand that if I falsify any of the above information, I will not be eligible for assistance now and/or in the future.