Canadian Tire Jumpstart Application

Residing in the Avalon Region?
Wondering How to Get Involved?
1. Contact your local Avalon Chapter
Submission Contact or the Inclusive
Services Coordinator. Contact information
can be found on the next page.
For further information on the Canadian Tire
Jumpstart Program please contact:
Inclusive Services Coordinator at
576-8601 or 576-2574
Or email [email protected] or visit
www.canadiantire.ca/jumpstart/
2. Please Mail, Fax or Drop off applications
to:
Mailing Address:
c/o Inclusive Services Coordinator
City of St. John’s
Canadian Tire Jumpstart Program
P.O. Box 908, St. John’s,
NL A1C 5M2
Drop-Off:
H.G.R. Mews Community Centre
40 Mundy Pond Road
Avalon Chapter Submission Contacts
Mount Pearl
748-1046
Conception Bay South
834-6643
Paradise
782-3808
Portugal Cove – St. Phillips 895-8000
Pouch Cove
335-2270
Torbay
437-6532 ext. 226
All Other Communities
576-6972
Wedgewood Park Recreation Centre
47 Gleneyre Street
Fax:
576-2308
Application Deadlines
Summer – May 20
Fall – August 21
Winter/Spring – December 3
Confidentiality of all
applicants will be protected!
Canadian Tire Jumpstart
Avalon Chapter Vision
“To give all youth in the Avalon
region the opportunity to participate
in organized sport and recreational
activities with their peers; regardless
of their family financial status.”
Canadian Tire
Jumpstart
Canadian Tire Jumpstart
Purpose
Canadian Tire Jumpstart is a
charitable program created by the
Canadian Tire Foundation for Families
to help kids in financial need participate
in organized sport and recreation.
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Canadian Tire Jumpstart assists financially
disadvantaged families (based on meeting an
established eligibility criteria--the Federal Low
Income Cut-off (LICO) Guidelines) in getting
their children aged 4-18 involved in sports and
physical activity.
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Recipients must be between 4 to 18
years of age.
More than one member of a family
can apply for each season.
Funding should be for a sustained
program that lasts a season.
Applications must be completed in
full, including reference section and
submitted by deadline date.
Applicants cannot attend more than
one paid sport program per season.
Applicants must provide proof of
income in form of an income
assessment, up to date T4 or 3
consecutive pay stubs.
Application
194,000 Children
and Youth
Supported in 2014!
Funding Guidelines:
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Grants will not exceed a maximum
of $300 per application or $600 per
year. (Please note a chapter cannot
guarantee maximum grants will be
awarded as it is based on available
funding).
The program must be a minimum of 5
hours in duration over at least 5
sessions. For example, a program
which runs for a minimum of 5 weeks
in duration for a period of at least 1
hour each week, or a program that
runs for a minimum of 1 hour a day for
5 consecutive days.
Guardian’s First Name: _______________
Guardian’s Last Name: _______________
Size of Family Unit: __________________
Total Family Income:
Less than $29,440.00
$29,441.00 to $36,193.00
$36,194.00 to $43,942.00
$43,943.00 to $49,839.00
$49,840.00 to $56,209.00
$56,210.00 to $62,581.00
More than $62,581.00
Address: __________________________
City: ______________________________
Postal Code:________________________
Phone Number: _____________________
Email: _____________________________
Child’s Name: ______________________
Child’s Date of Birth (dd/mm/yyyy):
__________________________________
Gender: ___________________________
Program Information
Signature of Consent
Activity: ___________________________
Activity Contact Information:
__________________________________
Program Start Date: __________________
Program End Date: __________________
How many weeks will the program run? __
How many days a week will the program
run? ______________________________
How long each day will the program take
place? ____________________________
My signature verifies that all of the above
information is true and that financial
assistance is required from Canadian Tire
Jumpstart in order for my child to
participate. I also acknowledge that
Canadian Tire Jumpstart may contact the
above listed sport organization as required
(i.e. to confirm funding approval, to
request an invoice for program payment).
Will you be receiving funding from any
other source at this time (KidSport,
R.E.A.L. Program)? ________________
Will the applicant be registered or involved
in any other recreation programs at this
time? If yes, please explain:
__________________________________
__________________________________
Amount Requested:
Registration $_________
Equipment $__________
Proof of income submitted:
Income Assessment
Most Recent T4
3 Consecutive Pay Stubs
Guardian’s Signature: ________________
__________________________________
Date: _____________________________
Please submit your completed
application and proof of income to your
local coordinator; email/ drop off
information provided by phoning:
Mount Pearl
748-1046
Conception Bay South
834-6643
Paradise
782-3808
Portugal Cove – St. Phillips 895-8000
Pouch Cove
335-2270
Torbay
437-6532 ext. 226
All Other Communities
576-6972