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.

First Name
Last Name
Relationship to child
Address
Home Phone Number

Example: ###-###-####
Alternate Phone Number

Example: ###-###-####
Email Address

Example: [email protected] Your submission will be sent to this address.

Child Information

Please enter the details of the child you are applying for.

First Name
Last Name

Birth Date

Open the calendar popup.

Family Make Up

Single Parent/Dual Parent/Guardianship
Do you Expect to or have you recieved funding from an alternate source?

If yes, please provide details.
Level of Play for your child this current year.

Mite/IP/Tyke/Novice/Atom/Peewee/Bantam/Midget/Juvenile

Application Details

Introduce yourself, your child and any and all circumstances pertaining to this application.

Please tell us your story.

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.

I agree to the terms and conditions stated above^*

Human Validation

Check The Box ^*

Application for Financial Assistance (Lakefield Minor Hockey)

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