CAP Program Re-Enrollment

Do you live in Chestermere?YesNoPlease review the full Community Access Program offerings and eligibility before completing your application.

Please check which program(s) you are interested in by checking the box of program(s) belowMonthly Transit Subsidy ONLY (Adult or youth)Monthly Transit Subsidy ONLY (Senior)Full Community Access Program Membership (Membership includes below programs)

Camp chestermere subsidy
Calgary Yacht Club Subsidy
Chestermere Library Card
Chestermere Recreation Subsidy
Harmony Health and Fitness
Kids up front tickets – monthly opportunities
Volunteer tax program
Synergy membership
TELUS spark passes
White cappers membership
Rockyview bus

APPLICANT INFORMATION:

First Name *

Last Name *

Date of birth

Sin #

SPOUSAL INFORMATION:

First Name

Last Name

Date of birth

CONTACT INFORMATION:

Street Address *

Postal Code *

Email Address *

Phone *

TRANSIT APPLICANTS ONLY:

Any client in the household and approved pick-ups outside the household (limit 2) Must present their OWN photo ID at the time of pick-up.

First Name

Last Name

Email Address

INCOME VERIFICATION:

Please ensure all fields are filled out.

Upload notice of assessment

3 Months of bank statements

Upload files

BUDGET TRACKER:

Please fill out this budget tracker with a rough estimate of your monthly expense’s vs income.

Monthly Income

Rent/ Mortgage Payment

Monthly Car Expenses

Monthly groceries

Utilities

Phone Bill

OTHER

CONSENT and STATEMENT:

I consent to the following:

I am the main applicant, and it is my responsibility to inform all members of my household about the programs and conditions of use.
I Give the City of Chestermere my permission to check the information within this application and upload into their necessary database.
I provide the City of Chestermere permission to share information within this application among different Chestermere subsidy programs.
The City of Chestermere may contact me and/or my alternate contact in matters pertaining to the application,
The information provided is true.
Misuse of program misinformation provided on this applicant may result in a loss of privileges or penalty
I understand that I am eligible to receive up to 500.00 per year transit as a single household, and 750.00 as a family.
I understand I must re-apply each new year.

Application Date *

Signature of applicant *