What is ? Am I Eligible? - Brimbank City Council

What isLanguage linkBRIMBANKAPPLICATION FORM?Arabic 9209 0131Croatian 9209 0132Greek 9209 0133Italian 9209 0134REFERRAL AGENT USE ONLY(If applicable)Name of organisation:Contact person:Contact phone number:Email address:In2Sport Brimbank provides an opportunity for childrenliving in Brimbank to actively participate in communitysport and recreation, regardless of their financialcircumstances. Eligible participants aged between6 -18 years can apply for up to $200 financialassistance to contribute to club fees. The fees willbe passed on directly to In2Sport Brimbank registeredsports clubs through Brimbank City Council.Macedonian 9209 0135Serbian 9209 0136Spanish 9209 0137Turkish 9209 0138Vietnamese 9209 0139All other languages 9209 0140English 9209 0141Local call costs apply2013/14Signature:Return Application Form to:Referral agentParent/guardianIn2Sport Brimbank is an inclusive program suitablefor people living with a disability.Based on a program developed by the Departmentof Sport and Recreation Western Australia.BRIMBANK CITY COUNCIL USE ONLYApplication Form validatedRecipient register updatedReturned to applicant or referral agentSignature:Date:/ /Invoiced by the club on:/ /Approved financial year: / /Am I Eligible?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 Brimbank.Please refer to ‘What else do I need to know’ section.Brimbank City CouncilSunshine 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.

What else do I needto know?Funding will assist 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 District LeadershipSurname: Training ProgramMaleFemaleName: Date of birth: / / Age:Contact What suburb details: do you live in?Address:Was the applicant born overseas? Yes NoIf yes, which country?Home phone:Does the applicant have a disability? Yes No☐Mobile: Has the applicant registered with a club before? Yes NoHow do Iget involved?Step 1Applicant’s complete the ‘In2Sport Brimbank ApplicationForm’ and submit it to Council to be validated. Applicant’smust attach a copy of their families Health Care Card orPension Concession Card.Step 2Council 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 Council for the cost of the feesup to $200 per child.Fees are only for the nominated registered season.No retrospective fees will be paid.No limitation to applications per family as longas the criteria is met.Sports clubs must be based in Brimbank, be not forprofit, affiliated with their State Sporting Body and beregistered with In2Sport Brimbank.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?Leisure Services on 9249 4529or sport@brimbank.vic.gov.auEmail: If yes, when?(year)What application period are you applying for?Summer sport Winter sportPlease include your CV with the application formHave they received In2Sport Brimbank funding before? Yes NoHow did you hear about In2Sport Brimbank? y(a paragraph each 2-3 sentences)School Sports Club Council Newspaper ☐Other Please specifyAre What you sport 18 would years the old applicant and over? like to play? Yes / NoWhat Brimbank Sports Club would the applicant like to join?What 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 Disclaimer: All information collected can be used only in mattersrelating to In2Sport Brimbank.Name:Were you born overseas? Yes NoIf yes, which CountryAddress:What Postcode: would you like to gain from this 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 Leisure ServicesPO BOX 70, Sunshine, Victoria 3020Please turn overEXPIRY DATE: