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1 FINANCIAL ASSISTANCE APPLICATION CHECKLIST All blanks in Steps 1, 2, 3 and 4 are filled in a complete. 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 Mail or Forms to: Spirit of the Game Society c/o Board of Directors PO Box 1303 Osoyoos, BC V0H 1V0 mike@sotgsociety.com QUESTIONS:

2 STEP 1 CHILD INFORMATION APPLICATION FOR FINANCIAL ASSISTANCE 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 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: 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: Fax: Sport Organization Signature: Telephone: Sport Registration Fee: $ (not including fundraising bonds, canteen bonds, pictures, etc.) Program Dates: Start End

3 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 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 WITHOUT THE EXPRESS WRITTEN CONSENT OF THE APPLICANT

4 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 th St. Osoyoos, BC V0H 1V5. (250) 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: Fax: Relationship to Child (i.e. Parent/ Sponsor/ Guardian/ other):

5 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) 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 Kick (circle) XS Sm. Med. Lg. Adult Sm. Adult Med. Adult Lg. Adult XLg.

6 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.** For Spirit Of The Game Office Use Only Name: Signature: Town: Date: