What is ? Am I Eligible? - Brimbank City Council
What is ? Am I Eligible? - Brimbank City Council
What is ? Am I Eligible? - Brimbank City Council
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<strong>What</strong> <strong>is</strong>Language linkBRIMBANKAPPLICATION FORM?Arabic 9209 0131Croatian 9209 0132Greek 9209 0133Italian 9209 0134REFERRAL AGENT USE ONLY(If applicable)Name of organ<strong>is</strong>ation:Contact person:Contact phone number:Email address:In2Sport <strong>Brimbank</strong> provides an opportunity for childrenliving in <strong>Brimbank</strong> to actively participate in communitysport and recreation, regardless of their financialcircumstances. <strong>Eligible</strong> participants aged between6 -18 years can apply for up to $200 financialass<strong>is</strong>tance to contribute to club fees. The fees willbe passed on directly to In2Sport <strong>Brimbank</strong> reg<strong>is</strong>teredsports clubs through <strong>Brimbank</strong> <strong>City</strong> <strong>Council</strong>.Macedonian 9209 0135Serbian 9209 0136Span<strong>is</strong>h 9209 0137Turk<strong>is</strong>h 9209 0138Vietnamese 9209 0139All other languages 9209 0140Engl<strong>is</strong>h 9209 0141Local call costs apply2013/14Signature:Return Application Form to:Referral agentParent/guardianIn2Sport <strong>Brimbank</strong> <strong>is</strong> an inclusive program suitablefor people living with a d<strong>is</strong>ability.Based on a program developed by the Departmentof Sport and Recreation Western Australia.BRIMBANK CITY COUNCIL USE ONLYApplication Form validatedRecipient reg<strong>is</strong>ter updatedReturned to applicant or referral agentSignature:Date:/ /Invoiced by the club on:/ /Approved financial year: / /<strong>Am</strong> I <strong>Eligible</strong>?Applicant’s must be aged 6 – 18 years.Applicant’s family must have a HealthCare Card or Pension Concession Card.Applicant’s primary place of residencemust be within <strong>Brimbank</strong>.Please refer to ‘<strong>What</strong> else do I need to know’ section.<strong>Brimbank</strong> <strong>City</strong> <strong>Council</strong>Sunshine OfficeAlexandra AvenueSunshine, Victoria 3020PO Box 70, SunshineVictoria 3020T 9249 4000F 9249 4351W brimbank.vic.gov.auYou could be eligiblefor up to $200 to joina sports club.
<strong>What</strong> else do I needto know?Funding will ass<strong>is</strong>t in covering the cost of fees to jointhe nominated sports club, which may include otherrelated costs identified by the club.Applicants can recieve 75% of membership costs with amaximum $200 per child per year; subject to budgetavailability.When are applications open?Applications open from September 1st 2013.All successful applications will be valid for 6 weeks fromapproval date.Application will not be accepted after:• January 6th 2014 for Summer sports• June 2nd 2014 for Winter sportsBRIMBANKAPPLICATION FORMApplication form forAPPLICANT DETAILS (CHILD)First St name: Albans D<strong>is</strong>trict LeadershipSurname: Training ProgramMaleFemaleName: Date of birth: / / Age:Contact <strong>What</strong> suburb details: do you live in?Address:Was the applicant born overseas? Yes NoIf yes, which country?Home phone:Does the applicant have a d<strong>is</strong>ability? Yes No☐Mobile: Has the applicant reg<strong>is</strong>tered with a club before? Yes NoHow do Iget involved?Step 1Applicant’s complete the ‘In2Sport <strong>Brimbank</strong> ApplicationForm’ and submit it to <strong>Council</strong> to be validated. Applicant’smust attach a copy of their families Health Care Card orPension Concession Card.Step 2<strong>Council</strong> validates the Application Form and returnsthe form to the applicant.Step 3Applicant submits the Application Form to the clubwhen joining club.Step 4The club invoices <strong>Council</strong> for the cost of the feesup to $200 per child.Fees are only for the nominated reg<strong>is</strong>tered season.No retrospective fees will be paid.No limitation to applications per family as longas the criteria <strong>is</strong> met.Sports clubs must be based in <strong>Brimbank</strong>, be not forprofit, affiliated with their State Sporting Body and bereg<strong>is</strong>tered with In2Sport <strong>Brimbank</strong>.If your children arejoining a club, whynot join as welland volunteer?You will be doing something to help your childrenIt will bring the family closer togetherYou will learn new skillsSporting clubs are a great way to meet people and formfriendships for all the familyWho do I contact formore information?Le<strong>is</strong>ure Services on 9249 4529or sport@brimbank.vic.gov.auEmail: If yes, when?(year)<strong>What</strong> application period are you applying for?Summer sport Winter sportPlease include your CV with the application formHave they received In2Sport <strong>Brimbank</strong> funding before? Yes NoHow did you hear about In2Sport <strong>Brimbank</strong>? y(a paragraph each 2-3 sentences)School Sports Club <strong>Council</strong> Newspaper ☐Other Please specifyAre <strong>What</strong> you sport 18 would years the old applicant and over? like to play? Yes / No<strong>What</strong> <strong>Brimbank</strong> Sports Club would the applicant like to join?<strong>What</strong> are your key areas of interest and why?(Arts and Culture, Aged Care and Health Services,Local PARENT/GUARDIAN Laws and Local Government, DETAILS Youth, Employment)Privacy D<strong>is</strong>claimer: All information collected can be used only in mattersrelating to In2Sport <strong>Brimbank</strong>.Name:Were you born overseas? Yes NoIf yes, which CountryAddress:<strong>What</strong> Postcode: would you like to gain from th<strong>is</strong> leadership program?Mobile:Home: ( )Email:Signature:Please attach a photo copy of your Health Care or Pension Concession Card.Return completed forms to sport@brimbank.vic.gov.au or Le<strong>is</strong>ure ServicesPO BOX 70, Sunshine, Victoria 3020Please turn overEXPIRY DATE: