Apply Online

* indicates a mandatory field

Participant Information:

*First Name:*

*Last Name:*


*Date of Birth (yyyy-mm-dd):*



Postal Code:


Parent/Guardian/Adult Information:


*Relationship to Child:*

Address: (if different than above)

*Home Phone:*

Work Phone:

Cell Phone:

*Your Email:* (required)

To be considered for any funding or other services that may be provided by youthreach, youthreach is hereby released from any and all claims that I or my child may have with respect to the activity that is to be funded by youthreach and by clicking send at the end of this application I voluntarily agree with this statement in its entirety.





Organization Contact:

Club Mailing Address:

Postal Code:



*Program Start and End Date:*

*Registration Fee:*

Discount from Organization/Club:

*Amount requested from youthreach (typical grants are $250 per participant annually):*

If possible attach a photo or scan of program provider’s registration form with this application so payment can be seamlessly made to your account if approved. NOTE: FILE SIZE MUST BE UNDER 10mb


Income Information:
Please complete sections A and B to show your current financial situation.

*Number of Adults In The Home:*

*Number of Children/Youth In The Home:*

*A) Please attach a scan of the most recent income tax notice of assessment for all family members over the age of 18 (living in the household).


B) Verification:
An objective third party who is familiar with the family and in a professional position to verify the financial barriers facing the family.

*Check one of the following: *
Social services / social workerTeacherPrincipalPolice OfficerLawyerMember of Clergy




*Phone Number:*

*Email: *

If you can’t complete sections A and/or B but are still interested in applying for support please email explaining how you can show your income information.

By clicking the Send button I agree that the individual identified to verify your application is aware that your family has financial need for support and he or she would be agreeable to being contacted by youthreach for follow-up if required.

By clicking the Send button you also agree to future inquiries from YouthReach regarding the success of your child’s experience in order to share success stories to positively impact fundraising efforts.