Application Form Step 1 of 2 - APPLICANTS INFO: 50% APPLICANTS INFO:Applicant's Name:*Applicant's AddressStreet Number:*Street Name:*Town of Residence:Date of Birth:Parent or Guardian Name:Email (Required):* Telephone Number (Required):*ORGANIZATION INFO:Organization Name:*Program Contact Name (Required):* ACTIVITY INFO:Activity:Start Date:End Date:Registration Cost: $Equipment Cost: $To make sure HTKP can support as many children as possible, what % of the cost could you pay? 0% 25% 50% 75% FUNDING INFO:Parent or Guardian are financially unable (Yes/No/Unsure):Parent/Guardian Signature:Additional Comments (Required):*Please include financial reasons why your child should be considered.Consent/Confirmation (Required):* I consent to having Help the Kids Play store my submission in order to apply to the program. I confirm that I have accurately portrayed my financial situation. Help the Kids Play - Application form Chairperson: Tim Osmond timo@helpthekidsplay.ca 416-951-7157 6825 3rd Line, Tottenham ON, L0G 1W0 Application NumberThis field is hidden when viewing the formDate of Application DD dash MM dash YYYY PhoneThis field is for validation purposes and should be left unchanged.
