Richmond, CA · Contra Costa County
Low Income Resident Fee Adjustment Application
Richmond residents use this application to request a fee adjustment for eligible Elevate summer camp or afterschool program registrations.
What this form is
The application asks Richmond residents to verify residency, their relationship to the child registering, and family income to request a program registration fee adjustment. Eligibility conditions must be met at registration, and the completed application and required documents are due then. The form says the adjustment applies only to eligible Elevate summer camp and afterschool registrations; excursions and listed programs are excluded.
Who needs it
A Richmond parent or legal guardian registering a child for an eligible Elevate summer camp or afterschool program may apply if the family meets the income requirements.
How to submit it
Submit the completed application with required verification documents at program registration; the form does not give a submission address or method.
About notarization
This application is signed and dated without a notary; it includes the applicant’s certification under penalty of perjury, but no notarized attachment is specified.
How to submit this form
- 1
Download the Application
Download the Low Income Resident Fee Adjustment Application.
- 2
Complete the Application
Print legibly and provide the requested household, program, residency, relationship, and income information.
- 3
Gather Required Documents
Attach proof of residency, relationship to the child, and family income as described on the form.
- 4
Submit at Registration
Provide the completed application and required documents at the time of program registration.
Frequently asked questions
- Do I need a notary for the Low Income Resident Fee Adjustment Application?
- No. The application has a signature and date line and a certification under penalty of perjury, but it does not require a notary or specify notarized attachments.
- Who can apply for a fee adjustment?
- A Richmond resident who is the parent or legal guardian of the child registering may apply if the family meets the income requirements.
- Which program fees can be adjusted?
- The form limits adjustments to eligible Elevate summer camp and afterschool program registration fees. Excursion fees must be paid in full, and several listed programs are excluded.
- How do I submit the application?
- Complete the application and provide the required verification documents at program registration. The form does not provide a submission address or method.
Need something notarized?
This Low Income Resident Fee Adjustment Application doesn’t need a notary — but if you have another Richmond form that does, a commissioned online notary can help.