Application Form Please fill out the web application form below and submit or print the application form and return it to: Tim Osmond – firstname.lastname@example.org | 416-951-7157 6825 3rd Line, Tottenham ON, L0G 1W0 Child's Name* First Last Date*Town of Residence*Age*Parent or Guardian Name* First Last Telephone:*Email:* Recreational Organization:*Contact Name for Organization*Address:* Street Address Town Postal code Email:* Registration Cost: $*Equipment Cost: $Your privacy is important to us. Only the Help the Kids Play Executive Committee will know the full name of the applicant. Criteria for fundingPlease indicate Yes or NoParents(s) or guardians(s) are financially unable:* Yes No Parent/Guardian Signature:Who referred you to HTKP:Additional Comments:Consent* I consent to having Help the Kids Play store my submission in order to apply to the program.* EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.