Online Application Form

This is a Confidential Service, Please ensure you have read the Guidelines.
Forms Must be Competed in Full.

STEP 1: PRE QUALIFICATION:
Have you applied to other organizations and/or foundations for financial support for this calendar year? (Pro Kids, Kidsport, Canadian Tire Jumpstart, or other foundations)

Have you applied to other organizations and/or foundations for financial support for this calendar year? (Pro Kids, Kidsport, Canadian Tire Jumpstart, or other foundations) Yes No
Funded by:
If yes, amount of money received?
STEP 2: CHILD INFORMATION
Name Child/Youth: * First Last
Birth Date * / DD / MM YYYY
Age *
Gender *

Gender Female Male Non-binary
If your child currently participating in an activity? (OTHER than the activity you are applying for)

If your child currently participating in an activity? (OTHER than the activity you are applying for) Yes No
If Yes - Which Activity:
If yes, Start Date: / MM / DD YYYY
If yes, End Date: / MM / DD YYYY
STEP 3: PROGRAM INFORMATION
Activity:
How long is this activity (eg. 8 weeks, 10 weeks, etc.)
Name of Organization:
Organization Contact Name:
Organization Contact Phone: - ### - ### ####
Cost of Activity (ticket fees; costumes and uniforms will not be covered): $ . Dollars Cents
Do not include insurance, tryout fees, uniforms, tournaments, transportation or equipment)
STEP 4: PARENT/GUARDIAN INFORMATION (Living in the Household):
Name of Parent/Guardian 1
(Making the request): *
Name of Parent/Guardian 2/Partner: *
Complete Mailing address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Ensure information is Accurate or Could result in Processing Delays
Western Valley Region participants may apply
See Regional Map, plus the community of Nackawic-Millville).
Phone Day * - ### - ### ####
Phone Evening - ### - ### ####
E-Mail *

Note: We request that a current email address be provided as the results of your application wil be sent electronically.
Number of children 18 & under living in the household: (Fulltime)
Please check the options that apply to you that lives within your household:
2 Parents/Adults Single Parent/Adult Foster Parent(s) Grand Parent(s) Married Common Law Separated Divorced
Occupation & Employer Parent/Guardian 1 (Person who is applying)
Occupation & Employer Parent/Guardian/Partner 2
Please check the options that apply to your current household income:

Please check the options that apply to your current household income: 0 - $19,999 $20,000 - $39,999 $40,000 - $59,999 $60,000 - $79,999 $80,000 or more
Further Information may be required to complete the application process.
If you need any assistance, please call (506) 375-0814
*
I have read ALL the GUIDELINES
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.
*
I agree.
Signature
Date * / DD / MM YYYY
Upload a File

Attach Files Attach Files
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: connie.trecartin@rogers.com.

Once you click on the “Submit” Icon and the form goes “Blank” it HAS been sent “Successfully!” DO NOT REDO!!!!

Online Application Form

Online Application Form

STEP 1: PRE QUALIFICATION:

STEP 2: CHILD INFORMATION

STEP 3: PROGRAM INFORMATION

STEP 4: PARENT/GUARDIAN INFORMATION (Living in the Household):

Western Valley Region participants may apply See Regional Map, plus the community of Nackawic-Millville).

Further Information may be required to complete the application process.

If you need any assistance, please call (506) 375-0814

Once you click on the “Submit” Icon and the form goes “Blank” it HAS been sent “Successfully!” DO NOT REDO!!!!

Western Valley Region participants may apply
See Regional Map, plus the community of Nackawic-Millville).