Application Form Step 1 of 2 - APPLICANTS INFO: 50% APPLICANTS INFO:Applicants Name:* Town of Residence: Date of Birth: Parent or Guardian Name: Email (Required):* Telephone Number (Required):*ORGANIZATION INFO:Organization Name:* Contact Name: Email (Required):* Telephone Number (Required):*Organization Address: Street Address Town Postal code 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 NumberHiddenDate of Application DD dash MM dash YYYY NameThis field is for validation purposes and should be left unchanged.
