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Please note that this form should be submitted at least one month prior to activity registration date.

Late requests may not be able to be accommodated.

Funds are limited and requesting assistance or previous approval through A.L.L. for Kids does not guarantee that you will receive assistance.

Please allow 2-3 weeks to process application.

Be sure what you are applying for is what you and your child want. Requesting changes to your application are difficult to process and sometimes unable to be accommodated.

 Phone  Email
 Yes  No  Unsure
Spouse / partner in the home (even if they are not the biological parents of the child)

What type of support is the applicant receiving

O.W. (Ontario Works) - If yes, move to 'Activities Requested' section.
O.W. - Temp Care Assistance - If yes, move to 'Activities Requested' section.
O.D.S.P. - (Ontario Disability Support Program) - If yes, move to 'Activities Requested' section.
Childcare Subsidy - If yes, move to 'Activities Requested' Section.
O.W. - Emergency Assistance - If yes, complete yearly income information section.
O.W. - Extended Employment Health Benefits - If yes, complete yearly income information section.
A.C.S.D. through O.D.S.P. - If yes, complete yearly income information section.
Yearly income (be sure this is complete, true and accurate as you will be required to provide copies of these documents to verify this information if requested by the program)
2018 or 2019 Notice of Assessment (line 236 "Net Income") OR 2018 Canada Child Benefit Statement ("2018 Family Net Income")
Applicant
Spouse / Partner in the Home
If you do not have your NOA or CCB Statement you will need to Contact Revenuw Canada at 1-800-959-8281
Activities Requested - Only requests listed on this form can be processed – changes or additions will require a new form.
Child name: *
Child birthdate: *
Activity of Interest: *
Organization: *
Start Date (Month): *
Cost: *

(total amount of dollars you are requesting for this activity -
If you are unsure of the information please check with the activity provider to confirm information before submitting your form)


Add Second Activity – only allowed if first activity request is 3 months or less


Add additional children (2)


Add additional children (3)


Add additional children (4)
Initial noting: "I understand": I certify that I am the parent/guardian of the children who I am requesting activities for, and these children reside with me full time or more than 50% of the time.
Initial noting: "I understand": I certify that the above information provided on this application is truthful, complete and to the best of my knowledge. I understand providing false information to obtain benefits may result in disqualification from the fee assistance program. I understand that upon approval, I will be required to submit the current year’s Canada Child Tax Benefit Statement or N.O.A.’s if requested by the program.
Upon approval, I give permission for the Municipality of Chatham-Kent, A.L.L. for Kids program, to submit my child’s name, child’s birthdate, and parent’s name and phone number to the above organization to advise of the funding approval; as well as to any retail stores for subsequent requests to advise of funding approval for equipment. Initial noting: “Check to give permission”: * 
A.L.L. for Kids is in part funded through the Canadian Tire Jumpstart program. If my child(ren) is/are funded under the Canadian Tire Jumpstart program, I give permission for the Municipality of Chatham-Kent, A.L.L. for Kids program, to submit my child’s name, birthdate and mailing address to the Canadian Tire Jumpstart Foundation in the form of a grant report. If my child(ren) is/are funded under the Canadian Tire Jumpstart program, I give permission for the Canadian Tire Jumpstart Foundation to contact me. Initial noting “Check to give permission”: *  
Having issues? Contact us by e-mail, or our call center at 519-360-1998 (regular business hours are Monday to Friday, 8:30 AM to 4:30 PM)