Smaller Text Button Larger Text Button - The Official Website of the City of Clearwater, Florida
Home Information Services Activities Government Employment Site Map Espanol Contact Us

Healthy Choices apple logoHealthy Choices for a Healthy Clearwater Card
Application Form

For Clearwater Residents Only

Fields in WHITE are REQUIRED

Fields in GRAY are OPTIONAL

Your Name: (Last, First, MI)


Unit #
Note: If you live in an apartment or condo, the Post Office will not deliver your card unless you provide a unit number.



Zip Code:

Phone # (w/ Area Code):

Date of Birth: (mm/dd/yyyy)


Your E-Mail Address:

Yes, I pledge to make at least one healthy choice each day. Please send me a Healthy Choices card that can be used for discounts at participating businesses.