Jump Start Application Form

Section 1: Application Information

Name:

Birth date:

Gender:

Male

Female

Address:

City/Town:

Province:

Postal code:

Telephone:

Email:

Section 2: Request for Funding

I would like to request funding for:

Sport or activity

Registration fees

Other

Organization name:

Fee amount: $

Organization contact:

Telephone:

Address:

City/Town:

Postal code:

Please indicate sport or recreation activity start date:

Please indicate length of sport or recreation activity:

Section 3: Endorsement

1) Parent / Guardian / Counsellor

Name:

Please indicate relationship to applicant:

Address:

City/Town:

Province:

Postal code:

Telephone:

Email:

I certify my submission of the above child/youth and verify that all the information given is correct and can be substantiated

I certify my submission of the above child/youth and verify that all the information given is correct and can be substantiated.

Signature of adult:

Sign above

Date:

2) Community Leader / Professional

Please attach a letter from a Community Leader indicating relationship to applicant and a verification of the applicant’s economic barrier to participate in the requested activity or program. The Community Leader should be in a position to identify and assess the economic barriers of the applicant.

Add an attachment

Maximum 3 files.
10 MB limit.
Allowed types: pdf, doc, docx.

Organization name:

Position:

Address:

City/Town:

Province:

Postal code:

Telephone:

Email:

Canadian Tire JumpStart and its members will respect the confidentiality of all applicants

For Office Use Only

Application received:

Application complete:

Accepted:

Reason:

First-time funding:

Amount ($):

Allocation period:

Cheque #:

Cheque date:

Alerts

Jump Start Application Form

Section 1: Application Information

Section 2: Request for Funding

Section 3: Endorsement

1) Parent / Guardian / Counsellor

2) Community Leader / Professional