Playing for Keeps

Section 1. Participant Information

Applications for children/youth up to age 21 are invited to apply
What county does the participant reside in?*

Hastings CountyNorthumberland CountyPrince Edward County

Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Has the child/applicant above received funding from The Children’s Foundation in 2024?*

YesNo
Which program did the child receive funding for?

Section 2. Highland Shores Children's Aid
What is your worker’s name?
If applicable
Worker's email address
example@example.com
Do you currently have an open file involved with the Highland Shores Children’s Aid Society?*

YesNo

Section 2. Qualifying Criteria
Annual gross Household income before taxes.*
Per your current Income Tax return for all individuals.
Please attach proof of income of all parents/guardians who live in the household. Acceptable proof is an image document of your current CCB (Canada Child Benefit) notice of assessment. (Acceptable file formats: pdf, jpg, jpeg, png, screenshots) Visit our program's page on our website to learn how to obtain this form.

Cancelof
I have uploaded my CCB Notice of Assessment for proof of income. This is mandatory.*

yes

Section 3. Organization Information

Program organization name, such as the YMCA, Quinte West Soccer Club, etc.
Program Organization Name *
If yes, please attach a copy of your ODSP or OW slip (acceptable file formats: pdf, jpg, jpeg, png)

Cancelof
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization email*
example@example.com
Contact telephone*
Type of activity*
soccer, music, art, cheerleading etc
Approximate start date of activity*

MonthDayYear
Date
Approximate end date of activity*

MonthDayYear
Date
Total registration cost*
The total cost for the length of the program.
Funding amount available
Previous funding for the current year.
This registration is for (pick one)*

One session (ie. one program for a set number of weeks) or,Ongoing sessions (program runs all year, weekly lessons etc)Other
Do you have an invoice for your child's activity program? Upload it here.

Upload confirmation of enrollment.
Cancelof
I have uploaded a file/picture of the invoice.*

yesno - I need to send funding approval to the Organization first.
Is there anything else you'd like us to know?
Internal Comments
The Children's Foundation is a donor supported Organization. How will this funding impact your child and family positively?*
Invoice I.D. #
Amount funded
Date Funds mailed

MonthDayYear
Date

Section 4. Permissions & Signature

Almost done!
I have thoroughly read and understand the guidelines of Playing for Keeps and agree that this application meets the guidelines and is truthful.*

Yes
I give The Children's Foundation permission to contact me for testimonials and impact stories.*

YesNo
Guardian Signature*

Clear
Date signed*

MonthDayYear
Date
If you have any questions about this form, please submit an email to info@thechildrensfoundation.ca
Should be Empty:

Playing for Keeps Application