Not-Approved Previous/Current Card Expiry Date:

Over LICO $_______ _______________________________

Form
Out of Town
HH # ___________
NEW EXPIRY DATE:

Leisure Access Program (44) Application

Saskatoon Transit Discounted Bus Pass Program

Required Information and Documents (COPIES ONLY - these are NOT returned to you):
1. What is your household’s/family’s total annual income before taxes? $______________.
2. Check which Program(s) you are applying for:
 Leisure Card Program  Discounted Bus Pass Program (for Transit use)
3. □ COPY of Notice of Assessment from the previous year.
 You must submit a COPY of the previous year’s Revenue Canada Notice of Assessment for yourself AND your
spouse/partner. This is one document we use to verify your income. You may be asked for additional
information. If you need a copy of your Income Tax Notice of Assessment, call 1-800-959-8281 and it will be
mailed to you. This is the ‘Option C Form – Income & Deductions’. Make sure that the amount from line
150 of the Notice is equal or lower than the Low Income cut-off numbers on the back of this form.
 If Section One of your Notice of Assessment has your name and current physical address, please provide
that page for proof of Saskatoon Address.
□ COPY of proof of Saskatoon address showing current name and address. Example: current utility bill, government
issued letter (drivers licence not accepted).
4. Applicant’s Information – Use legal names (please print clearly).
Last Name First Name Leisure Card Number (staff use only)
HASAN MOHAMMED

Address
103A - 1505 McKercher Drive

City Postal Code Home or Cell Phone E-Mail Address

Saskatoon S7H 5J9 306-250 0254 [email protected]
Birth Date MM/DD/YY Gender: Marital Status:
03/14/92 Male  Single  Living as a Couple  Married  Widowed  Separated

5. Information about your family– Use legal names. NOTE: Member photos will be taken at time of LeisureCard
purchase. Photos will not be used for purposes other than member verification. ONLY include your partner/spouse
and your children who are younger than 19 years old. They must be related to you by blood, marriage, adoption, legal
guardianship, or living as a couple. All other household members must apply on their own.
Last Name First Name Relationship Gender Date of Birth LeisureCard #
Month/Day/Year Staff Use Only

7
Mail or drop off your completed applications (in the envelope provided) to:
By Mail: Community Development Branch Drop it off at any City Leisure Facility
3130 Laurier Drive Attention: Leisure Access Program
Saskatoon, SK S7L 5J7
It takes a minimum of 3-4 weeks to approve a Leisure Card. Incomplete applications take longer to process.
Incomplete applications are returned to you with instructions on what is missing. Applications are processed in the order
received to ensure fairness. Go to at www.saskatoon.ca for more information or contact [email protected] or
306-975-3383. Make sure you have checked the Income cut-offs on back of form to see if you qualify.

Terms and Conditions for the Leisure Access Program LeisureCard

1. Cards cannot be shared (they are not transferable). You must show your card when you go to a facility or you will need to pay the admission price.
2. If there is fraudulent use of this card, you will lose your card.
3. LeisureCards are available at Cosmo Civic Centre, Harry Bailey Aquatic Centre, Lakewood Civic Centre, Lawson Civic Centre, Saskatoon Field
House and the Shaw Centre.
4. The City can close all, or part, of any facility for maintenance and/or special events.
5. If you lose your card, it can be replaced at any leisure centre for a cost of $5/card plus GST.
6. The City has the right to ask the Card holder for proof of identity.
7. Member’s photos will be taken at time of LeisureCard purchase. Photos are only used member verification at site.

I I certify that I am a current resident of Saskatoon, that the information provided is accurate, and I meet the income
requirements. I have read and understand the terms and conditions listed for the Card. I agree to follow the terms and
conditions as outlined above. I am aware that if any information I have provided is fraudulent, my LeisureCard(s) may be
withdrawn.

__________________________________________
Signature of Person applying Date Signed
Details about this program:
The City of Saskatoon Leisure Access Program offers a one-year, free LeisureCard for families or
individuals whose household income is below a certain level. (Please see the chart below.)
The LeisureCard gives unlimited access to any of the City of Saskatoon’s 6 indoor leisure centres,
outdoor pools and the Terry Fox walking track at the Sasktel Soccer Centre. With your LeisureCard
you can:
 swim during public swim times, use the gyms and weight rooms and skate at Cosmo Civic
Centre arena.
 attend drop-in fitness classes as many times as you would like.
 sign up for one free registered recreation program per year, such as swimming lessons or
fitness classes.
 request free admission tickets for the Potash Corp Playland (formally Kinsmen Park Rides)
The Discounted Bus Pass Program
Each eligible family member can purchase a bus pass at a cheaper rate. (Social services clients
should check with their worker.)
Adult Pass $66.40 High School Pass $47.20 Child Pass $40.00
Do you qualify?
1
How many people, including yourself, are in your immediate family and live in your home? ________
You must include your spouse/partner and your children who are less than 19 years old.

You are eligible for these programs if your household income was less than these amounts in
the chart below.
Look at your last year’s Income Tax Notice of Assessment. This is only one tool used to qualify you
for the program.

# of people in the 1 person 2 3 4 5 6 7+

household people people people people people people
Maximum income / $21,822 $27,165 $33,396 $40,548 $45,988 $51,868 $57,747
year to qualify

Required Documents:

6. You must submit a COPY of last year’s Income Tax Notice of Assessment for yourself AND your
spouse/partner (if you have one). We do not accept any other document as proof of income. If you
do not have a copy of your Income Tax Notice of Assessment, you can get one by calling
1-800-959-8281, and it will be mailed to you. Ask the Tax office for the ‘Option C Form – Income &
Deductions’.

7. This program is ONLY for City of Saskatoon residents. To prove you are a resident of Saskatoon,
please submit a COPY of a document that has your name and current address. The acceptable
forms are: a utility bill, or a telephone bill, or a government issued letter. We will not accept a
driver’s licence for proof of residency.

Questions about the Leisure Access Program? Please call 306-975-3383

Email: [email protected]
Questions about the Discounted Bus Pass Program? Please call 306-975-3100

Notice: Personal information collected from you is collected in accordance with Part IV of the Local
Authority Freedom of Information and Protection of Privacy Act. The information will be used to
determine eligibility for the Accessible LeisureCard and Discounted Bus Pass Program and to refer you
to other programs or services for which you may be eligible. Documents will be destroyed once they
have been reviewed. You may direct questions about the collection, use, or disclosure of your
personal information by this program, by calling the Community Services Department at
306-975-3383 or email: [email protected].

Revised May 2018

LICO Number valid from June 1, 2018 – May 31, 2019