Please only fill out this application for additional elite sport funding if your athlete is between the ages of 13-17 OR if the athlete ages 5-17 has suffered a recent loss of a parent or sibling. Section 1: Child Information Child Name * First Name Last Name Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Gender * Male Female Date of Birth * MM DD YYYY Current Age * Section 2: Sport Organization Sport Organization * Sport Being Played Are you applying for additional funding to access an "elite" sport? * Examples include but are not limited to AMHA AAA, AMHA AA, elite dance. Yes (please provide details) No Please provide details about your elite sport, here. * Sport Start Date * MM DD YYYY Sport End Date * MM DD YYYY Total Registration Cost * $ Requested Registration Amount * Proof of Sport Registration must be emailed post form submission. Amounts to be approved by the KLF board on an as case basis as funding is available. $ Do you require equipment? If so, indicate below. * Yes No Equipment Needed Section 3: Adult Sponsor (Parent/Guardian) Parent/Guardian Name * First Name Last Name Mailing Address If different from Child's above. Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Relationship to Athlete * Number of Adults in home (18+) * Number of children in home (-18) * Disclaimer I am authorized to enter into this agreement as the parent or legal guardian or the participant. I understand that my digitally typed signature below reflects my agreement to hereby release, waive, discharge, and covenant not to sue or take any legal action against the Kalix Legacy Foundation (KLF), the directors of KLF and their officers, employees, volunteers and agents and remove them from liability for any and all claims including, but not limited to, personal injury, accident or illness (including death) and property loss arising from, but not limited to, participation or activity that is funded, supported or organized by KLF. Declaration * Full Name of approving parent/guardian. Have you applied for KidSport? * Yes No If no, why? * Please let us know. Have you applied for JumpStart? * Yes No If no, why? * Please let us know. Have you applied for Hockey Canada grants? Yes No If no, why? * Please let us know. Have you ever received funding from KLF in the past? * Yes No If yes, please provide details including the year funded. * Please provide a brief explanation of your family circumstances and let us know how additional funding / bereavement funding for sports would benefit your child. * Section 4: Proof of Income Total yearly gross household income. * Please include alimony, spousal support, child support, etc... Please include 1 of the following documents * You will need to email it after submitting the form. Child Health Benefits Letter Canada Child Benefit Notice (Page 1 & 2) Subsidized Housing Form Income Support Current Calgary (Fair Entry) or Airdrie Fee Assistance Card (include exp. date) Notice of Assessment (each adult in home for most recent tax year) A Notice of Assessment can be obtained by calling 1-800-959-8281 All sections of the application must be filled out completely. Incomplete and illegible forms will be returned. Please email your proof of sport registration and income document to kalixlegacyfoundation@hotmail.com. Thank you! Someone from our team will be reviewing your application and be in touch.Please do not forget to email your documents:Proof of Sport Registration.Proof of Income document (that you selected).Emails should be sent to kalixlegacyfoundation@hotmail.com.We appreciate your support and cooperation. The Kalix Legacy FoundationExtenuating Circumstances Application Form
