Individual Application | Children's Museum (Winnipeg, MB)

Applicant Information

First & Last Name*

First Last

Address*

Street Address Address Line 2 City Province Postal Code

Daytime Phone Number*

Email Address*

Eligibility Information

Does this request meet one (or more) of the criteria listed in the Eligibility Guidelines above?*

Yes
No

Note: Due to high demand, the criteria listed above are guidelines only. Meeting these guidelines does not imply or constitute donation approval.

What Proof of Eligibility documentation will you be supplying?*

How will you be supplying your Proof of Eligibility documentation?*

In Person
Attached to this online request form

Note: Your request will only be reviewed by the Free2Play Access Committee upon confirmed receipt of your Proof of Eligibility documentation.

Proof of Eligibility Documentation (Online Request)*

Drop files here or

Max. file size: 5 MB, Max. files: 5.

Please upload any of the Proof of Eligibility documentation outlined above.

Other Information

How many child passes are you requesting?

Each pass is valid for 1 general museum admission.

How many adult passes are you requesting?

Each pass is valid for 1 general museum admission.

Would you like to be considered for an Annual Individual Membership instead of general admission passes?*

Yes
No

Note: Membership support is discretionary.

Are you a client of any of the following organizations? (Please check all that apply.)

Note: Some requests can be expedited via a partner organization.

Is there any other information you would like to bring to our attention for consideration with this application?

Declaration: I declare that the information provided by me on this application form is accurate & complete, and that any false or misleading statements may be sufficient ground for cancelling any arrangement made. I also understand that this application form does not guarantee support through the Free2Play Access Program. I understand that assistance from the Children’s Museum is discretionary.*

Yes
No

Would you like to receive our monthly eNews updates?*

Yes
No

# of People in Household	Household Income
1	$24,949
2	$31,061
3	$38,185
4	$46,362
5	$52,583
6	$59,304
7	$66,027
More than 7	For each additional person, add $6,723