Application Form For more info contact: Sport Makes a Difference

Your Donation Counts
Sport Makes a Difference!
Due to the generous support of our
program partners, all administration costs
for KidSport are covered. This ensures that
100% of your donation goes directly to the
kids.
• Sport helps kids become stronger:
mentally and physically.
TM
Yes, I would like to help an
underprivileged kid participate in sport.
Please return this form with your gift of:
$20
$25
$35
$50
I prefer to give $
A receipt will be issued for gifts of $20 or more.
Charitable Registration No: 889386868 RR0001
I would like my donation to go towards:
The next child from my local chapter.
The next child in the sport of
Please make your cheque payable to:
KIDSPORTTM
I prefer to use my
Visa
Mastercard
Card #
Card Expiry Date
Signature
Name
• By being involved in spor t, k ids
develop positive relationships with
other kids and adults while establishing
the basis for relationships of trust and
build teamwork skills.
• Children who are physically active tend
to perform better in school and are less
likely to smoke.
• Active kids generally have active families.
Almost two-thirds of children who are
active have at least one parent who is
also involved in organized sport.
• Children need 30 minutes of physical
activity every day to improve fitness and
health levels.
For more info contact:
KidSportTM Nova Scotia
5516 Spring Garden Rd., 4th Floor
Halifax, NS
B3J 1G6
Phone: 902.425.5450 ext. 350
Fax: 902.425.5606
[email protected]
OR your local KidSportTM Chapter:
Colchester:
1 Church Street
PO Box 697
Truro, NS
B2N 5E7
Tel: 902.897.3155
Fax: 902.895.9983
East Hants:
2361 Hwy #2
PO Box 190
Shubenacadie, NS
B0N 2H0
Tel: 902.758.2715
Fax: 902.758.3497
Website: www.sportnovascotia.ca
National Site: www.kidsport.ca
KidSportTM
Program Partners
Application Form
Funding Partner
Premier Partner
Address
City/Province
Postal Code
Phone
E-mail
I would like to receive information and updates
related to KidSportTM (check box)
About KidSport
KidSport is a national children’s charitable
program that helps disadvantaged kids overcome the barriers preventing or limiting their
participation in organized sport.
TM
KidSport Nova Scotia provides funding of up
to $300/year/child for sport registration and/or
equipment.
Application Form (to be completed by an adult)
Allocation Policies
PARENT/GUARDIAN INFORMATION
1. Total grant (registration and equipment) will not exceed
a maximum of $300. Grants for equipment only will
not exceed $200.
Parent/Guardian
Address
City
Postal Code
Daytime Telephone
E-mail
Check One:
Single-Parent Family
Dual-Parent Family Number of children in the family
Annual Household Income: (Please check one) See Fund Allocation Policy # 8.
Less than $15,000
$15,000 - $19,999
$20,000 - $29,999
Over $30,000
2. Recipients must be under 19 years of age.
3. A child cannot receive more than one grant in a calendar
year.
4. Preference is given to athletes who are being
introduced into organized sport for the first time.
5. Sport organizations must be a member of Sport Nova
Scotia. Please visit www.sportnovascotia.ca for an
updated list of members.
Proof of income must accompany application. See Fund Allocation Policy # 11. Funds will be awarded based on availability.
6. Applicants must be registered with a sport in order
to receive financial assistance for equipment. Proof
of registration is required.
Signature of Parent/Guardian
TM
In operation since 1994, KidSport Nova Scotia
has allocated over three-quarters of a million
dollars to help children take part in organized
sport.
TM
The need for KidSport
APPLICANT INFORMATION
7. Grants are awarded for registration fees and
equipment costs only.
Child’s Name
Date of Birth
Address
City
Postal Code
Telephone
male
female
Name of sport participating in
Name and mailing address of league, association or club that cheque is payable to
8. Approval is based on National Council of
Welfare Estimates of Statistics Canada. For more
information visit www.ncwcnbes.net/documents/
researchpublications/OtherFactSheets/PovertyLines/
2006ENG.pdf.
9. Applications are accepted six times per calendar year;
deadlines are January 1st, March 1st, May 1st, July 1st,
September 1st, and November 1st.
TM
• One-third of Canadian parents with children
under the age of 18 have been unable to
register their children in organized sport due
to expenses.
• 32 % of children in Nova Scotia between
two and 17 years of age are either overweight or obese. The national average is
26 %.
• According to statistics, over 47,000 Nova Scotian children live below the poverty line. With
the increasing costs associated with playing
organized sport each year thousands of
Nova Scotia’s children are prevented from
participating.
Is this the first time participating in this sport?
Yes
No
If no, how many years has he/she been involved?
Has this athlete received previous KidSportTM funding?
10 Application form(s) will not be approved until all
information is received.
See Fund Allocation Policy # 4.
Yes
11. Proof of total family income must accompany
application form. You must include A or B:
DEPARTMENT OF COMMUNITY
SERVICES STAMP HERE
No
A. Proof of total family income (for tax return or
notice of assessment call 1-800-959-8281); or
Grant Request: Expenses for the grant will be used for:
Registration/Participation Fees
$
Equipment Request
$
Total Request
$
B
SIGNATURE HERE
Type of Equipment
12. Applicants will receive a letter no more than four (4)
weeks after the deadline notifying them of the status
of their application.
* If request is for equipment only, please provide proof of registration.
Is there a Cleve’s / Source for Sports 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 KidSportTM
B. Authorization from the Department of Community
Services or community services agency (for office
locations visit www.gov.ns.ca/coms/contactus/
offices.html).
Yes
No
IMPORTANT KidSportTM Nova Scotia and its affiliated chapters agree that any information provided by the applicant shall be retained by
IMPORTANT:
KidSportTM Nova Scotia and/or its affiliated chapters and shall 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).
13. Cheques for registration grants will be made
payable to a league, association or club. Cheques for
equipment will be made payable to a sporting goods
retailer. (Note: KidSport reserves the right to request
proof of purchase.)
TM