Application Form - Help The Kids Play

Please fill out the web application form below and submit or print the application form and return it to:

Tim Osmond – timo@helpthekidsplay.ca | 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 funding
Please indicate Yes or No
Parents(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.*
Name
This field is for validation purposes and should be left unchanged.

Criteria for funding