Application Form

GRANT INFO
1 Applicants must be aged 18
or younger.
2 Grants are awarded for
registration fees and
equipment costs only.
3 Total grant will not exceed
$300.
Application
Form
Contact us for more info
KidSport Nova Scotia
5516 Spring Garden Rd.
4th Floor
Halifax, NS B3J 1G6
P: 902.425.5450 ext. 350
F: 902.425.5606
E: [email protected]
www.kidsportcanada.ca
facebook.com/kidsport-nova-scotia
twitter: @kidsport_ns
OR your local KidSport Chapter:
KidSport
Halifax Regional Municipality
(same address as above)
KidSport is provincially operated by:
www.sportnovascotia.ca
facebook.com/sportnovascotia
twitter: @sportnovascotia
4 Grants for equipment only
will not exceed $200. Proof
of registration is required to
receive financial assistance
for equipment
5 A child can only receive one
grant in a calendar year.
6 Cheques for registration
grants will be made payable
to a league, association or
club. Cheques/vouchers for
equipment will be made
payable to a sporting goods
retailer. (Note: KidSport
reserves the right to request
proof of purchase.)
APPLICATION INFO
1 Sport organizations must
be a member of Sport Nova
Scotia. To view members, visit
www.sportnovascotia.ca.
2 Approval is based on
Statistics Canada’s Low
Income Cut-offs. (visit:
http://tinyurl.com/hr4v787)
3 Application form(s) will
not be approved until all
information is received.
4 Complete applications will
receive a letter no more
than four weeks after the
deadline notifying them
of the status of their
application.
Application Form (to be completed by an adult)
PARENT/GUARDIAN INFORMATION
Parent/Guardian
Address
CityPostal Code
Daytime TelephoneE-mail
Choose One:
Single-Parent
Dual-Parent
Number of children in the family
Signature of Parent/Guardian
APPLICANT INFORMATION
Please select a deadline you are applying for:
January 4 March 1
May 2
July 4
September 1
November 1
Child’s NameDate of Birth
Address
CityPostal Code
Telephone
male
female
Name of sport participating in
Name and mailing address of league, association or club that cheque is payable to
PROOF OF TOTAL FAMILY INCOME MUST ACCOMPANY APPLICATION FORM. YOU MUST INCLUDE A OR B:
A.
B.
OR
Proof of total family income (for tax summary or notice of assessment call 1-800-959-8281);
Authorization from the Department of Community Services or community services agency (for office
locations visit www.gov.ns.ca/coms).
Has this athlete received previous KidSport funding?
Yes
No
DEPARTMENT OF COMMUNITY
SERVICES STAMP HERE
Grant Request: Expenses for the grant will be used for:
Registration/Participation Fees
Equipment Request
Total Request $
$
$
Equipment:
SIGNATURE HERE
* If request is for equipment only, please provide proof of registration.
Is there a Sport Chek location in your area?
Yes
No
If no, please indicate the name, address and phone number of the nearest sporting goods retailer:
I would like to receive information and updates related to KidSport
Yes
No
IMPORTANT: KidSport Nova Scotia and its affiliated chapters agree that any information provided by the applicant shall be retained by KidSport
Nova Scotia and/or its affiliated chapters. Information may be released to funding partners upon request, but will not be released to any other
party without the expressed written consent of the applicant (other than the sport organization for which funding has been requested).
Funding Partner
Program Sponsors