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STEP 1: PRE QUALIFICATION:
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Have you applied to other organizations and/or foundations for financial support for this calendar year?
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STEP 2: CHILD INFORMATION
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Name Child/Youth: *
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Birth Date *
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Gender *
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If your child currently participating in an activity?
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Have you received funding in this calendar year?
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Funding by:
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STEP 3: PROGRAM INFORMATION
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Phone
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Are there tryouts?
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If Yes indicate date:
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Registration Fees Only:
$
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Do not include insurance, tryout fees, uniforms, tournaments, transportation or equipment)
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STEP 4: PARENT/GUARDIAN INFORMATION:
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Complete Mailing address: *
Ensure information is Accurate or Could result in Processing Delays
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Phone Day *
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Phone Evening
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Note: We request that a current email address be provided as the results of your application wil be sent electronically.
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Please check the options that apply to you:
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Please check the options that apply to you:
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Further Information may be required to complete the application process.
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If you need any assistance, please call (506) 375-0814
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*
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I authorize the above references to release personal/financial information as required for program placement with P.R.O. Kids to collect the information. I further authorize P.R.O. Kids to collect this information. My signature (and/or type signature) also verifies that financial assistance is required from P.R.O. Kids in order for my child to participate. In addition, I assume full responsibility for the supervision of my child while participating in activities. I further understand that P.R.O. Kids is not liable for any injuries, loss or death as result of participation in registered recreation activities.
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*
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Date *
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Click Submit below to complete your application.
Personal information on this form is collected under the Personal Information Protection and Electronic Documents Act (PIPEDA) to maintain a record of individuals participating or utilizing courses, activities or facilities. Questions can be directed to Western Valley P.R.O. Kids (506) 375-0814.
For further information, e-mail: kent.kuhn@gnb.ca.
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