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Applicant Information

Title II Compliance
In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit https://www.modestogov.com/865/Americans-with-Disabilities-Act-ADA.
First Name*
First name of applicant, or the guardian or parent of applicant if the applicant is a youth.
Last Name*
Last name of applicant, or the guardian or parent of applicant if the applicant is a youth.
Spouse's First Name
If you have a spouse, is their last name the same as yours?
1. Yes
2. No
Last Name*
Email Address*
Email address of applicant, or their guardian or parent.
Daytime Telephone Number*
Alternate Telephone Number
Street Address*
City*
State*
Zip Code*
Is the above address your mailing address?
1. Yes
2. No
Mailing Address*
City*
State*
Zip Code*
Is this a renewal application?
1. Yes
2. No
Previous Leisure Bucks Number*
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Instructions
Print this completed form and bring or mail with the following documentation to the Parks, Recreation and Neighborhoods Department at 1010 Tenth Street, 4th Floor, Modesto, CA 95354.
Proof of Address*
Bring one of the above
Proof of Age*
Bring one of the above
Proof of Income*
Bring one of the above
Proof of Certified Disability*
Bring one of the above.
Proof of age*
Bring one of the above.
Proof of Income*
Bring one of the above
Proof of Address*
Bring one of the above
Proof of Age*
Bring one of the above
Proof of Income*
Bring one of the above. Note that all children applying must be listed as dependents on documents.

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