FINANCIAL ASSISTANCE APPLICATION CHECKLIST
All blanks in Steps 1, 2, 3 and 4 are filled in a complete.
QUESTIONS: 250-689-0422
Mail or Email Forms to:
Spirit of the Game Society
c/o Board of Directors
PO Box 1303
Osoyoos, BC V0H 1V0
email:
[email protected]
INDIVIDUAL EQUIPMENT APPLICATION CHECKLIST
All blanks in Steps 1 & 2 are filled in a complete.
Please make sure all equipment needed is listed on provided pages, along
with detailed sizing needs
I am aware that I am responsible for any and all shipping costs associated with
receiving the equipment
Childs Last Name: _____________________________________ Child’s First Name: ____________________________________ Address: ___________________________________________________________________________________________________ City: _____________________________________ Province: _____________ Postal Code: ________________________ Male Female Age: _______ Birth Date: Year: _________ Month: ________ Day: ___________ Number of Dependent Children in Family (Age 15 and under): ______________
Sport Child will be Participating in: _________________________________________ Number of Years in Sport: ______________ Registration Fee: $_____________ Minus Portion Family will Pay: $__________ = Total Funding Request: $_____________
I authorize Spirit Of The Game Society to discuss the status of this application
Parent/ Sponsor/ Guardian Signature: ___________________________________________ Date: ________________________
STEP 1 CHILD INFORMATION
STEP 2 PARENT/ SPONSOR/ GUARDIAN INFORMATION
** The Parent/ Sponsor/ Guardian will act as the contact person for the child & will receive all correspondence**
Last Name: ______________________________________ First Name: _______________________________________________ Address (if different from Child’s): ___________________________________________________________________________________
City: ___________________________________________ Province: __________________ Postal Code: __________________ Telephone: Home: _______________________________ Work: _____________________ Cell: ________________________ Email: ______________________________________________________________________ Fax: _________________________ Relationship to Child (i.e. Parent/ Sponsor/ Guardian/ other): _______________________________________________________________ Please check one: Single Parent Married Common Law
Do any of the following apply to your family? Social Assistance Foster Parent
STEP 3 SPORT INFORMATION
** Please take this form to the Sport Organization/ Club for Completion**
Sport Organization/ Club: ______________________________________________________________________________________ Cheque to be Made Payable to: _________________________________________________________________________________ Mailing Address: _____________________________________________________________________________________________ City: ______________________________________ Province: _________________ Postal Code: _______________________ Contact: ________________________________________________________________ Position: __________________________ Email: __________________________________________________________________ Fax: ______________________________ Sport Organization Signature: _______________________________________________ Telephone: ________________________ Sport Registration Fee: $___________________________________(not including fundraising bonds, canteen bonds, pictures, etc.) Program Dates: Start ________________________________________ End ___________________________________________
STEP 4 FINANCIAL INFORMATION
I have provided the following supporting documents: (please check all boxes that apply)
Canada Customs and Revenue Agency NOTICE OF ASSESSMENT (NOA) (See funding Policy ‘A’) ( if married or common-law,
you must include both partners’ Notice of Assessment or the application will be considered incomplete
Proof of Social Assistance Status (See Funding Policy ‘B’) Proof of Foster Parent Status (See Funding Policy ‘B’) Copies of all Monthly Household Bills (i.e.: rent, hydro, etc.). Other Income: _________________________________
The Notice of Assessment(s) provided accurately reflects my current financial situation Yes No If NO, provide a letter explaining and provide proof of your current financial situation (i.e.: pay stubs).
SPIRIT OF THE GAME OFFICE USE ONLY
Total Household Income: $_________________________________
FUNDING POLICIES
A) A copy of Canada Customs and Revenue Agency Notice of Assessment (NOA) must be provided. Applications will not be processed without proof of income and additional financial information may be requested. If you do not have your most recent Canada Customs and Revenue Agency Notice of Assessment, contact Revenue Canada at 1800-959-8281.
B) If you are a Foster Parent for the child applying, or on Social Assistance, please provide proof of Foster Status or Social Assistance Status.
C) Financial Assistance to individual Athletes is designed to help children ages 15 and under who would not play a sport without Spirit Of The Game. Preference is given to children being introduced to a sport.
D) Sport Activities must be affiliated with organizations recognized within the South Okanagan. E) Funding cheques are sent directly to Sport Organizations/ Clubs.
Applications must be completed and received by the deadline to be considered.
If you need assistance completing this form please contact Spirit Of The Game Society
ALL INFORMATION PROVIDED IN THIS APPLICATION WILL BE RETAINED BY SPIRIT OF THE GAME
AND SHALL NOT BE RELEASED TO ANY OTHER PARTY
APPLICATION FOR INDIVIDUAL EQUIPMENT
The amount and type of equipment collected is limited. Please consider your equipment needs carefully
before submitting this application. Be aware that the fulfilment of your application will depend on
equipment availability (new & used).
Incomplete applications will not be considered.
FUNDING POLICIES
**Please read the following guidelines carefully before completing this form**
A) Equipment grants to individual athletes are designed to help those who would not play a sport without Spirit Of The Game’s help and will be provided if equipment is available, on a first come first serve basis.
B) Spirit Of The Game assists children aged 15 and under, with preference given to kids trying a sport for the first time. C) Spirit Of The Game will contact the recipient to collect his/ her equipment. The recipient is responsible for picking up the
equipment. Once notified the equipment will available for pick up at Sierra Self Storage– 11601 115th St. Osoyoos, BC V0H 1V5. (250) 495-2424.
D) All new and used equipment will be distributed as is.
NO APPLICATION DEADLINE– SUBJECT TO AVAILABILITY OF EQUIPMENT
STEP 1 CHILD INFORMATION
Childs Last Name: _____________________________________ Child’s First Name: ____________________________________ Address: ___________________________________________________________________________________________________ City: _____________________________________ Province: _____________ Postal Code: ________________________ Male Female Age: _______ Birth Date: Year: _________ Month: ________ Day: ___________ Number of Dependent Children in Family (Age 15 and under): ______________
Sport Child will be Participating in: _________________________________________ Number of Years in Sport: ______________
General Information
Age: ________ Height: ________ Weight: ________ Clothing Size: ________ Jacket Size: ________ Shoe Size: ________
STEP 2 PARENT/ SPONSOR/ GUARDIAN INFORMATION
** The Parent/ Sponsor/ Guardian will act as the contact person for the child & will receive all correspondence**
Last Name: ______________________________________ First Name: _______________________________________________ Address (if different from Child’s): ___________________________________________________________________________________ City: ___________________________________________ Province: __________________ Postal Code: __________________ Telephone: Home: _______________________________ Work: _____________________ Cell: ________________________ Email: ______________________________________________________________________ Fax: _________________________ Relationship to Child (i.e. Parent/ Sponsor/ Guardian/ other): _______________________________________________________________
STEP 3 EQUIPMENT SELECTION
Town: ________________ Last Name: ______________________ **If possible, please try on equipment (ex: a teammates, at a store) to ensure correct size**HOCKEY
YOUTH JUNIOR SENIOR
Helmets (circle) Sm. Med. Lg. Sm. Med. Lg. Sm. Med. Lg.
Shoulder Pads (circle) Sm. Med. Lg. Sm. Med. Lg. Sm. Med. Lg. Elbows Pads (circle) Sm. Med. Lg. Sm. Med. Lg. Sm. Med. Lg.
Glove (circle) Sm. Med. Lg. Sm. Med. Lg. Sm. Med. Lg.
Pants (circle) Sm. Med. Lg. Sm. Med. Lg. Sm. Med. Lg.
Shin Pads Yth. ________ inches Jr. ________ inches Sr. ________ inches Skates Size ______________ (usually one size lower than your running shoes)
Stick (circle) Left Right ** Goalie equipment may be available upon request**
SKATING
YOUTH JUNIOR SENIOR
Helmets (circle) Sm. Med. Lg. Sm. Med. Lg. Sm. Med. Lg.
Skates Size ______________ (usually one size lower than your running shoes)
SOCCER
JUNIOR SENIOR
Shin Pads (circle) Sm. Med. Lg. Sm. Med. Lg.
Shorts (circle) Sm. Med. Lg. Sm. Med. Lg.
Jersey (circle) Sm. Med. Lg. Sm. Med. Lg.
Socks (circle) Sm. Med. Lg. Sm. Med. Lg.
Shoes Size ______________ (same size as your running shoes)
Ball Size 3
(3-8 Yr. Olds)
Size 4
(9-12 Yr. Olds)
Size 5
(13 Yrs. .& Up)
DANCE
Child Body Suit (circle) 4-6 6-8 8-10 10-12 12-14 14-16 Other____ Color _________ Child Tights (circle) XSm. Sm. Med. Lg. XLg. Other ____ Color _________ Shoes Size _______ Style (circle) Jazz Tap Ballet Hip Hop Character Other ______ Color _________
GOLF
Clubs (circle) Left Right Shoes Size ______________ (same size as your running shoes)
CURLING
Shoes Size ______________ (same size as your running shoes) Slider (circle) Right Left Broom (circle) Child Youth Adult
MARTIAL ARTS
Uniform Weight __________ Height __________
Sparring Gear Punch (circle) Child Youth Adult Sm. Adult M/L Adult XL Head (circle) Child Youth Adult Sm. Adult M/L Adult XL
STEP 3 EQUIPMENT SELECTION
Town: ________________ Last Name: ______________________ **If possible, please try on equipment (ex: a teammates, at a store) to ensure correct size**OTHER EQUIPMENT
**Please list all items you require. Equipment will not be disbursed if it is not listed below. Please be as specific as possible with all sizes.**
Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________ Item Requested: _____________________________________________________ Size Requested: ______________________
