Play your Way Grant Form

Play Your Way Grant

Fill in the information below to apply for the Play Your Way Grant. This grant covers the cost of any PISE facilitated program or service for children and youth under 19 years of age. This includes camps, programs and memberships.

"*" indicates required fields

Personal Information

Applicant's Name*

Please enter the name of the child or youth that will be attending the program

Applicant's Date of Birth*

Enter the date of birth of the applicant that will be attending the program

Parent/Guardian Name*

Enter the name of the parent/guardian who is responsible for the submission of this form and the main contact during the application process.

Contact Email*

An email address for the parent/guardian that we can use to correspond with in relation to application.

Contact Phone Number*

A phone number that we can call regarding the application

Mailing Address*

Street Address Address Line 2 City Province Postal Code

PISE Services

Please enter the information regarding the PISE services that you are applying for.

Applying for*

List the name of the camp, program or membership that you are applying for on behalf of the the applicant.

Price*

Input the advertised price of the program, camp or membership that the applicant would like to attend. Please note that the cap for this grant is $800.00 per year. You may apply for a service that is a higher price but the grant may not cover the entire fee and the parent/guardian will be responsible for the remaining balance.

Bus passes required*

Bus Pass Required

No Bus Pass Required

In order to remove barriers to accessing our facility, are bus passes required to get to and from our location. If yes, bus passes will be mailed to the address listed.

Rationale and Reference

Rationale*

Please explain why the applicant requires financial assistance to participate in PISE programs and services. This may include, but is not limited to, social & economic barriers, any diagnoses or medical factors, immigration status, previous negative experiences in sport and physical activity.

Reference Name

First Last

Please provide the name of a reference who can verify the information included in the previous 'Rationale' section. This person may be a health professional such as physiotherapist or Occupational Therapist, a teacher, social worker, cultural liaison or any other person who can vouch for the family and their application rationale.

Reference Phone Number*

Please provide a phone number for the reference.

Reference Email*

Please provide an email address for the reference.