Request for Assistance

Please ensure that the application is fully completed.

Required fields are denoted with a *

PARENT / GUARDIAN INFORMATION

Name of Parent / Guardian *

Email *

Address *

Town/City *

Postal Code *

Telephone (Home or primary phone number) *

Telephone(Work)

Telephone(Mobile)

CHILD / YOUTH INFORMATION

Name of Participant (First and Last name required) *

Date of Birth(DD/MM/YY) *

Sex M/F *

Address - Check if same as Parent or Guardian's 

Town/City *

Postal Code *

Telephone

School Attending *

PROGRAM INFORMATION

What are you requesting funding for? *

Program Start Date(MM/YY) *

Program Finish Date(MM/YY) *

Hours per week participating in activity *

Name of Recreation/Sport Organization *

FUNDING CRITERIA

Is this the first time participating in this activity?
Yes No 
If No, how many years has the participant been involved?

Has the participant received previous funding from the MKF?
Yes No 
If Yes, please include when

Will you be receiving funding from any other source at this time?
Yes No 
If Yes, please indicate where this funding will come from as well as the amount:

Single or Two-Parent family? *

Other siblings? *

What ages?

Family income? *

Is there any additional information you'd like to include in your application

GRANT REQUEST

Please indicate what this grant will be used towards and include amounts
Registration Fees $ *

Equipment $

Total Request $ (PLEASE NOTE: REQUESTS CANNOT EXCEED $500.00) *