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Parks and Recreation Department

144 Wilson Avenue, Pocatello, Idaho 83201

208-234-6232

Empowering Parents Grant Funds Request

  • Completion of this form does not guarantee registration or space in a program until a receipt for the program has been received. 
  • You will be contacted via email for us to gather further information. Please allow us 48 hours during the work week to process requests.
  • Grant funds only cover those who are eligible under the funds.
  • Residency is based off of zip codes and those that pay utilities to the City of Pocatello.  
  • ID Cards are not covered by the grant and will be an additional cost payable at the recreation desk.
  • If grant funds are denied, parents will be responsible for the class fee or registration will be terminated.

Parent Information

Name

Address

Children Information

Child #1 Name

Child #1 Program(s) of Interest (check all that apply)

Child #2 Name

Child #2 Program(s) of Interest (check all that apply)

Child #3 Name

Child #3 Program(s) of Interest (check all that apply)

Child #4 Name

Child #4 Program(s) of Interest (check all that apply)

Child #5 Name

Child #5 Program(s) of Interest (check all that apply)

Child #6 Name

Child #6 Program(s) of Interest (check all that apply)