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:

Holiday Closures and Pickup Changes

Holiday Closures and Pickup Changes

Bills and Payments While Canada Post Returns to Normal Operations

Bills and Payments While Canada Post Returns to Normal Operations

Popular Links:

Section 1: Application Information

Section 2: Request for Funding

Section 3: Endorsement

1) Parent / Guardian / Counsellor

2) Community Leader / Professional

Alerts

Holiday Closures and Pickup Changes

Holiday Closures and Pickup Changes

Bills and Payments While Canada Post Returns to Normal Operations

Bills and Payments While Canada Post Returns to Normal Operations

Jump Start Application Form

Section 1: Application Information

Section 2: Request for Funding

Section 3: Endorsement

1) Parent / Guardian / Counsellor

2) Community Leader / Professional