Application for Financial Assistance (Lakefield Minor Hockey)

Print Application for Financial Assistance
Funds are available annually thanks to various sponsors and organizers associated with LDMHA. These funds vary from year to year and are dispersed to families who require assistance. To apply for funding, please complete an Application.
Parent/Guardian Information
Please provide Parent/Guardian Information below.
  1. Example: ###-###-####
  2. Example: ###-###-####
  3. Example: [email protected] Your submission will be sent to this address.
Child Information
Please enter the details of the child you are applying for.
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  2. Single Parent/Dual Parent/Guardianship
  3. If yes, please provide details.
  4. Mite/IP/Tyke/Novice/Atom/Peewee/Bantam/Midget/Juvenile
Application Details
Introduce yourself, your child and any and all circumstances pertaining to this application.
  1. I hereby certify, that the information provided on this application is true and accurate. 
    By agreeing, I make my application for financial assistance for my child/children/dependant to receive assistance, if possible, from the LDMHA. 

    In consideration of the right and opportunity to receive assistance from LDMHA, the undersigned (on behalf of the participant) completely release and discharge and shall hold harmless LDMHA against and from any and all claims and demand of any nature whatsoever, for damages and injuries but not limited to any claims from participating in hockey.  The undersigned acknowledges that the participant and their families have chosen to participate on their own free will.  This release shall further apply to all unsuspected, unknown, unanticipated and undisclosed claims, demands, liabilities, actions or causes of action, in law, equity or otherwise.

    By submitting this application, I am requesting and agreeing that without funding this child would otherwise not be able to play hockey.

    A copy of the most recent tax benefit may be requested for applicants. 

    I have read and understand the terms stated above and agree to all aspects of this release.
Human Validation
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Printed from lakefieldminorhockey.ca on Thursday, August 6, 2020 at 8:50 PM