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Jumpstart Application

Working together to provide recreation opportunities to children, youth and families in financial need.
The Jumpstart / RecKids Program is a joint effort between municipal Parks and Recreation and the Canadian Tire Jumpstart Program.
Jumpstart is designed to provide assistance to those who, due to financial constraints, would otherwise be unable to participate in
sport, art, cultural, and recreation activities. At this time, the municipality supports registered non-profit organizations only.
Season (only ONE program per child, per season)

Winter

Spring

Summer

Fall

HOUSEHOLD INFORMATION
PARENT / GUARDIANS NAME (FIRST AND LAST NAME)

PHONE

MAILING ADDRESS (INCLUDE CITY/PROVINCE/POSTAL CODE)

EMAIL

FAMILY
SINGLE PARENT
DUAL PARENTS
# OF CHILDEREN UNDER 18
PARTICIPANT INFORMATION
NAME (FIRST AND LAST NAME)

GENDER

AGE

DATE OF BIRTH (DD/MM/YY)

ACTIVITY OF CHOICE

ORGANIZATION NAME

REGISTRATION COST

ORGANIZATION CONTACT NAME AND NUMBER

START DATE

EMAIL OF ORGANIZATION

FINANCIAL INFORMATION
Proof of financial need must accompany application form. You must include one of the following:
A. Proof of total family income (Notice of Assessment) Approval is based on Statistics Canadas Low Income Cut-offs.
B. Letter or stamp from the Department of Community Services
Signature: __________________________________________

Department of Community Services Stamp

AUTHORIZATION
PARENT / GUARDIAN SIGNATURE

DATE

Please allow 2-3 weeks to process an application.


Delivery of application form and financial information can be made by:
Mail:
Captain William Spry Community Centre
16 Sussex Street Halifax, NS B3R 1N9
902-490-3894
www.halifax.ca/rec/JumpstartRecKids

Walk In:
Drop off your application package at any
municipal Recreation Facility
Fax: 902-490-1676
Email: jumpstart@halifax.ca

FOR OFFICE USE ONLY:


DATE RECEIVED:
PROCESSED BY:
TOTAL COST OF PROGRAM
MUNICIPALITY/JUMPSTART:
FUNDING ALREADY USED:

FRM-009-2015-Jumpstart

Jumpstart Application
Canadian Tire / Jumpstart Guidelines
1. Organizations must be registered non-profit with Joint Stocks Nova Scotia.
2. Children ages 18 and under are eligible to apply for funding.
3. The child must be a resident of the Halifax Regional Municipality and generally, the program must also take place in
the Halifax Regional Municipality.
4. Funding of (1) program per season to a maximum of $200 (periodically reassessed) per year to be used for the
payment of sport, art, music, cultural and recreational participation/registration fees.
5. Equipment, travel, fundraising, championships, private lessons, memberships etc. are not eligible expenses.
6. Applications must be received and approved prior to the start date of the program. Applications will not be accepted
after the program has started.
7. Jumpstart/RecKids Program does not reimburse parents; payment will be arranged directly with the organization
offering the activity.
8. Funding must be used by the participant for the activity/organization that was on the approved application. No portion
for the funds can be transferred to another person or organization. No substitutions may be made by either participant
or the organization.
9. *At the discretion of staff, applications can be reviewed on a case-by-case basis, and would include consideration of
any extenuating circumstances facing the family.

Use of Personal Information


In accordance with Section 485 of the Municipal Government Act (MGA), the personal information collected on this form will only be used
by staff for purposes relating to the administration of the Jumpstart/RecKids Program, including releasing necessary information to
program providers. The following personal information - first and last name, date of birth and postal code - will be disclosed to Canadian
Tire. If you have any questions about the collection and use of this information, please contact the Access and Privacy Office at 902-4904390 or accessandprivacy@halifax.ca.

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FRM-009-2015-Jumpstart