LIFE Application Form

The LIFE Program (Leisure Involvement for Everyone), provided by the Pemberton and District Recreation Services Department, provides an opportunity to Village of Pemberton and District Area C residents in financial need to participate in Leisure activities at a discounted rate. To apply you must be a Canadian Citizen or permanent resident living in Pemberton or Area C. Client confidentiality will be maintained. Immigrants who are classified as investors or entrepreneurs do not qualify, nor do those on temporary residents (visitor), study or work permits.


The LIFE Program provides the following benefits to those who qualify and enroll:
• 50% off one program per season per individual (some exceptions may apply)
• One 10-time fitness centre pass per family per year

In order to process your application, this form must be filled out completely:

Definitions:
• Family is defined as one or two adult(s), legally married or common-law partners, and their legal dependants aged 18 and younger.
• Total Family Income means a total combined income, before taxes, by all family members 19 years and older in Canada and abroad, contributing to the household’s income and expenses. This includes from: employment of all types (full and part-time, reported or not reported) all investments, pensions, child support payments, rental revenues, funds in trust, disability benefits (taxable or not) and all othersources.

Family Income Threshold (Source: Statistics Canada, Low Income Figures - for 2017 tax year)

Family Size

1 person 2 people 3 people 4 people 5 people 6 people 7 people

Family Income

$19,844 $24,703 $30,369 $36,874  $41,821  $47,168 $52,514

List all family members (including applicant) below:

Method A: Clients Providing Tax Documents
□ Current Notice of Assessment for each adult
in the family. The combined net income
from line 150 of all family members’ Notice of
Assessments must be $5,000 or more. A copy
can be obtained from Canada Revenue
Agency (1-800-959-8281)
□ T1 Worksheet for each adult in the family
□ Canada Child Benefit Notice

□ Proof of address (utility bill or bank statement
in the name of an adult applicant issued within
the last 3 months)
□ Government issued photo ID (Driver’s License,
BC ID, Passport or Permanent Resident card)


Method B: Clients of the Ministry of Social Development
□ Notice of Deposit from Ministry of Social
Development
□ If the address portion is missing, proof of
address is required (utility bill or bank statement
in the name of an adult applicant)
□ Canada Child Benefit Notice
□ Government issued Photo ID (Driver’s License,
BC ID, Passport or Permanent Resident Card)

 

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