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4. Application for Fee Waiver for Lap Swim & Water Exercise

   Use this application to apply for the Lap Swim & Water Exercise fee waiver program. Woodland residents ages 63 and older who meet low-income requirements may qualify for the fee waiver. Eligibility is based on the PG&E CARE program income guidelines. Applications for the fee waiver must be submitted annually.

6. First Name*
7. Last Name*
9. Phone Number*
10. Birthdate*
    Birthdate
12. Address*
    PO Boxes and county road addresses will not be accepted
14. City*
15. Zip Code*
16. Email Address
18. Total number living in household*
22. Proof of residency in Woodland*

    Upload a copy of your City of Woodland water bill, PG&E bill, rental agreement, or mortgage statement to verify your physical address and confirm residency within the City of Woodland.

24. Are you enrolled in the PG&E CARE program*

    1. Yes

    1. No
26. PG&E Bill

    Upload your most recent PG&E bill for proof of your enrollment in the PG&E CARE program.

28. Proof of Income Qualification

    If you are not enrolled in the PG&E CARE program, upload a copy of your income qualification for the Lap Swim & Water Exercise Fee Waiver Application. This is the 1040 of the 2024 tax submission. A W2 or a paycheck stub is not an acceptable income verification form.

30. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature
33. Date
    Date
Leave This Blank:


35. Submit

* indicates a required field