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Non-Resident Fee Subsidy Request

Date of Application:

Applicant's Name:

Email Address:

Home Telephone:

Work Telephone:

Mailing Address (including 911#):

Property Address (if different from Mailing Address):

Occupancy Status:

Own

Rent

Name of Youth participating in the sports programs(s) and date of birth (mm/dd/yy):

Sports Programs (excluding swimming lessons and day camps):

Total Non-Resident Surcharge Paid:

Attach the required verification documentation: Receipts for payment of non-resident surcharge issued by the City of Owen Sound

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Attach the required verification documentation: Copy of registration(s) for minor sport(s) issued by minor sports group(s) or organization(s).

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I agree that the above information and all the attached verification information supplied with this application is true and correct. Signature:

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Personal information on this form is collected pursuant to the Municipal Act, S.O. 2001, CHAPTER 25 as amended, and will be used to determine eligibility for financial subsidy assistance for registered participants in sports programs offered in the City of Owen Sound by not-for-profit groups or organizations.

NOTE: Subsidy is for minor sports only. This does not include swimming lessons or day camps. **Rebate must be processed by December 31st of the applicable year.**

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