LIFE Program Application 2024

Full Name (Primary Applicant)

Mailing Address (including postal code) - MUST be a resident of Esquimalt

Address

Address 2

City/Town

Province

Postal Code

Phone Number

Email Address

Birthdate

List Additional Household Members / Dependants (Names and Birthdates)

Please list all members of your household, including all dependant children (0-18 years) and a spouse/partner (if applicable). Please follow the following format: Firstname_Lastname mm-dd-yyyy; IE; Jane_Doe 01-05-1962 Please note: in common-law and martial situations, combined income is required for application. Therefore: both individuals will need to provide proof of income by showing individual notice of assessments.

Final Submission

Pass Option

OPTION A: 52 Free Admissions to Drop-in Sessions at any Greater Victoria Recreation Centre For use at Esquimalt, Saanich, City of Victoria, Oak Bay, Panorama, West Shore and SEAPARC. > Your L.I.F.E. card must be presented at the time of admission. > One card is issued once per year for each household member.
OPTION B: 52 Free Admissions to Drop-in Sessions at Esquimalt Recreation Centre ONLY (electronically added to Esquimalt's system)
OPTION C: 50% off annual Esquimalt only pass (total after discount: adult: $192.50, senior: $146.50, youth $100, child $80 > electronically added to Esquimalt's system)
OPTION D: 50% off Regional Recreation pass (total after discount: $276 > electronically added to Esquimalt's system, physical card needed to access all other centres)

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