Sporting Chance Application Form

Application Form

The Upper Hutt City Council recognises that COVID-19 has had a significant impact on our community. To support those experiencing financial hardship, Activation provides a Sporting Chance grant to assist young people where financial hardship is a barrier to participation in sport and physical activity.

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* 1. Contact Information

Applicants First Name

Surname

School

Date of Birth

Telephone

Street Address

City

Postcode

Email Address

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* 2. What sport is the applicant currently involved in, or wants to participate in?

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* 3. Which club does the applicant belong to, or wish to belong to?

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* 4. Purpose and kind of assistance needed

Footwear

Equipment

Fees / subs / classes

Costs (please specify each individual cost)

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* 5. Parent / Guardian

Name

Telephone

Street Address

City

Postcode

Email Address

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* 6. Conditions of Assistance

I agree to the conditions of assistance

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* 7. Briefly outline relevant family circumstances

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* 8. Specific child needs (detail)

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* 9. Referee

Name

Telephone

Organisation / Role

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* 10. Supporting Documentation

I have emailed all quotes and relevant information to activation@uhcc.govt.nz