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Anaheim Community Services VETERAN & ACTIVE MILITARY PERSONNEL DISCOUNT REQUEST (This is Confidential) Veterans and Active Military personnel and their immediate dependents are eligible to receive a 10% discount on designated Community Services Department programs and classes, up to a maximum of $10 per program or class. Dependents include spouses, children, and/or parents whom one contributes all or a major amount of necessary financial support. To receive this special discount, applicants must complete a Military Discount Application form and present a copy of your Active Duty Services or Veteran Identification Card. Please Print Applicant Name: Last First Middle Initial Address City Zip Home # Cell # Work # Email Address I affirm to the best of my knowledge and belief that the above statements are true. Signature Date List all Immediate Family Dependents Birthdate (if under 18) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) (FOR OFFICE USE ONLY) I hereby certify that the above family is eligible for the Veteran & Active Military Personnel Discount of 10% per activity/program (will not exceed $10 per activity or program). Registration Supervisor’s Signature Date Application expiration date