{"id":24543,"date":"2023-12-08T12:37:42","date_gmt":"2023-12-08T18:37:42","guid":{"rendered":"https:\/\/childrensmuseum.com\/?page_id=24543"},"modified":"2024-02-08T15:00:16","modified_gmt":"2024-02-08T21:00:16","slug":"individual-application","status":"publish","type":"page","link":"https:\/\/childrensmuseum.com\/visit\/accessibility\/free2play-access-program\/individual-application\/","title":{"rendered":"Individual Application"},"content":{"rendered":"<style>.kb-row-layout-id24543_cbe95f-d6 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id24543_cbe95f-d6 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id24543_cbe95f-d6 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);padding-top:var(--global-kb-spacing-sm, 1.5rem);padding-bottom:var(--global-kb-spacing-sm, 1.5rem);grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id24543_cbe95f-d6 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id24543_cbe95f-d6 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id24543_cbe95f-d6 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id24543_cbe95f-d6 alignnone wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top\">\n<style>.kadence-column24543_8522dd-c9 > .kt-inside-inner-col,.kadence-column24543_8522dd-c9 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column24543_8522dd-c9 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column24543_8522dd-c9 > .kt-inside-inner-col{flex-direction:column;}.kadence-column24543_8522dd-c9 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column24543_8522dd-c9 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column24543_8522dd-c9{position:relative;}@media all and (max-width: 1024px){.kadence-column24543_8522dd-c9 > .kt-inside-inner-col{flex-direction:column;}}@media all and (max-width: 767px){.kadence-column24543_8522dd-c9 > .kt-inside-inner-col{flex-direction:column;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column24543_8522dd-c9\"><div class=\"kt-inside-inner-col\">\n<p><strong>Prior to completing this application form, please note:<\/strong><\/p>\n\n\n\n<ul>\n<li>The Children\u2019s Museum has a Free2Play Access Program Committee that meets once a month to review all incoming requests. The Children\u2019s Museum requires a minimum of 6 weeks to review and process any incoming requests.<\/li>\n\n\n\n<li>Due to the number of requests received at certain times of the year, urgent requests will not be granted priority consideration \u2013 so please ensure that your application reaches us with adequate time for consideration prior to your anticipated visit date.<\/li>\n\n\n\n<li>Due to high demand, the criteria listed below are guidelines only. Meeting these guidelines does not imply or constitute donation approval.<\/li>\n\n\n\n<li>A limit of one application request per month applies.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Eligibility Guidelines<\/h3>\n\n\n\n<p>An individual may be eligible for a Free2Play Access Program general admission pass and\/or membership if:<\/p>\n\n\n\n<ul>\n<li>The parent\/guardian has a social assistance case number<\/li>\n\n\n\n<li>The parent\/guardian has a refugee assistance case number<\/li>\n\n\n\n<li>The child being registered has a subsidized childcare spot through the Province of Manitoba Child Care Subsidy Program&nbsp;<\/li>\n\n\n\n<li>The child\u2019s family income is below the low income cut-off (LICO) (amounts listed below)<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong># of People in Household<\/strong><\/td><td><strong>Household Income<\/strong><\/td><\/tr><tr><td>1<\/td><td>$24,949<\/td><\/tr><tr><td>2<\/td><td>$31,061<\/td><\/tr><tr><td>3<\/td><td>$38,185<\/td><\/tr><tr><td>4<\/td><td>$46,362<\/td><\/tr><tr><td>5<\/td><td>$52,583<\/td><\/tr><tr><td>6<\/td><td>$59,304<\/td><\/tr><tr><td>7<\/td><td>$66,027<\/td><\/tr><tr><td>More than 7<\/td><td>For each additional person, add $6,723<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><em>(Sources: Statistics Canada; Immigration, Refugees and Citizenship Canada; City of Winnipeg Leisure Guide)<\/em><\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<script type=\"text\/javascript\">var 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gfield_visibility_visible\"  data-js-reload=\"field_63_26\" ><h2 class=\"gsection_title\">Applicant Information<\/h2><\/li><li id=\"field_63_2\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_2\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >First &amp; Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_63_2'>\n                            \n                            <span id='input_63_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_63_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_63_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_63_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_63_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_63_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_63_3\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_3\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_63_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_63_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_63_3_1' value=''    aria-required='true'    \/>\n                                        <label for='input_63_3_1' id='input_63_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_63_3_2_container' >\n                                        <input type='text' name='input_3.2' id='input_63_3_2' value=''     aria-required='false'   \/>\n                                        <label for='input_63_3_2' id='input_63_3_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_63_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_63_3_3' value=''    aria-required='true'    \/>\n                                    <label for='input_63_3_3' id='input_63_3_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_63_3_4_container' >\n                                        <select name='input_3.4' id='input_63_3_4'     aria-required='true'    ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' selected='selected'>Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_63_3_4' id='input_63_3_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_63_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_63_3_5' value=''    aria-required='true'    \/>\n                                    <label for='input_63_3_5' id='input_63_3_5_label' class='gform-field-label gform-field-label--type-sub '>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_63_3_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_63_4\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_4\" ><label class='gfield_label gform-field-label' for='input_63_4'>Daytime Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_63_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_63_6\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_6\" ><label class='gfield_label gform-field-label' for='input_63_6'>Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_6' id='input_63_6' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_63_28\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_28\" ><h2 class=\"gsection_title\">Eligibility Information<\/h2><\/li><li id=\"field_63_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_27\" ><label class='gfield_label gform-field-label' >Does this request meet one (or more) of the criteria listed in the Eligibility Guidelines above?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_63_27'>\n\t\t\t<li class='gchoice gchoice_63_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Yes'  id='choice_63_27_0'    \/>\n\t\t\t\t<label for='choice_63_27_0' id='label_63_27_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_63_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='No'  id='choice_63_27_1'    \/>\n\t\t\t\t<label for='choice_63_27_1' id='label_63_27_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_63_27'>Note: Due to high demand, the criteria listed above are guidelines only. Meeting these guidelines does not imply or constitute donation approval.<\/div><\/li><li id=\"field_63_29\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_29\" ><label class='gfield_label gform-field-label' for='input_63_29'>What Proof of Eligibility documentation will you be supplying?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_29' id='input_63_29' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Copy of social assistance budget letter (including case number, case worker\u2019s name and contact information)' >Copy of social assistance budget letter (including case number, case worker\u2019s name and contact information)<\/option><option value='Refugee assistance case number and Case worker\u2019s name and contact information' >Refugee assistance case number and Case worker\u2019s name and contact information<\/option><option value='Copy of most recent Canada Revenue Agency Notice of Assessment identifying annual family net income (including the Notice of Assessment for your spouse\/partner)' >Copy of most recent Canada Revenue Agency Notice of Assessment identifying annual family net income (including the Notice of Assessment for your spouse\/partner)<\/option><option value='Copy of monthly statement of income from CPP Disability (including the income verification for your spouse\/partner)' >Copy of monthly statement of income from CPP Disability (including the income verification for your spouse\/partner)<\/option><option value='Proof Child Care Subsidy from Province of Manitoba such as the Confirmation Letter received when Child Care Subsidy was confirmed' >Proof Child Care Subsidy from Province of Manitoba such as the Confirmation Letter received when Child Care Subsidy was confirmed<\/option><\/select><\/div><\/li><li id=\"field_63_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_30\" ><label class='gfield_label gform-field-label' >How will you be supplying your Proof of Eligibility documentation?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_63_30'>\n\t\t\t<li class='gchoice gchoice_63_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='In Person'  id='choice_63_30_0'    \/>\n\t\t\t\t<label for='choice_63_30_0' id='label_63_30_0' class='gform-field-label gform-field-label--type-inline'>In Person<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_63_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='Attached to this online request form'  id='choice_63_30_1'    \/>\n\t\t\t\t<label for='choice_63_30_1' id='label_63_30_1' class='gform-field-label gform-field-label--type-inline'>Attached to this online request form<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_63_30'>Note: Your request will only be reviewed by the Free2Play Access Committee upon confirmed receipt of your Proof of Eligibility documentation.<\/div><\/li><li id=\"field_63_15\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_15\" ><label class='gfield_label gform-field-label' for='gform_browse_button_63_15'>Proof of Eligibility Documentation (Online Request)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_63_15' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_63_15&quot;,&quot;container&quot;:&quot;gform_multifile_upload_63_15&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_63_15&quot;,&quot;filelist&quot;:&quot;gform_preview_63_15&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/childrensmuseum.com\\\/?gf_page=2ae041710f0e25c&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/childrensmuseum.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/childrensmuseum.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;5242880b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:63,&quot;field_id&quot;:15},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;5&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_63_15&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_63_15' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_63_15' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_63_15 gfield_description_63_15\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_63_15'>Max. file size: 5 MB, Max. files: 5.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_63_15'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_63_15' class='ginput_preview_list'><\/div><div class='gfield_description' id='gfield_description_63_15'>Please upload any of the Proof of Eligibility documentation outlined above.<\/div><\/li><li id=\"field_63_32\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_32\" ><h2 class=\"gsection_title\">Other Information<\/h2><\/li><li id=\"field_63_34\" class=\"gfield gfield--type-number field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_34\" ><label class='gfield_label gform-field-label' for='input_63_34'>How many child passes are you requesting?<\/label><div class='ginput_container ginput_container_number'><input name='input_34' id='input_63_34' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_63_34\" \/><\/div><div class='gfield_description' id='gfield_description_63_34'>Each pass is valid for 1 general museum admission.<\/div><\/li><li id=\"field_63_35\" class=\"gfield gfield--type-number field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_35\" ><label class='gfield_label gform-field-label' for='input_63_35'>How many adult passes are you requesting?<\/label><div class='ginput_container ginput_container_number'><input name='input_35' id='input_63_35' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_63_35\" \/><\/div><div class='gfield_description' id='gfield_description_63_35'>Each pass is valid for 1 general museum admission.<\/div><\/li><li id=\"field_63_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_25\" ><label class='gfield_label gform-field-label' >Would you like to be considered for an Annual Individual Membership instead of general admission passes?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_63_25'>\n\t\t\t<li class='gchoice gchoice_63_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='Yes'  id='choice_63_25_0'    \/>\n\t\t\t\t<label for='choice_63_25_0' id='label_63_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_63_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='No'  id='choice_63_25_1'    \/>\n\t\t\t\t<label for='choice_63_25_1' id='label_63_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_63_25'>Note: Membership support is discretionary.<\/div><\/li><li id=\"field_63_33\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_33\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Are you a client of any of the following organizations? (Please check all that apply.)<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_63_33'><li class='gchoice gchoice_63_33_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.1' type='checkbox'  value='Alpha House Inc.'  id='choice_63_33_1'   aria-describedby=\"gfield_description_63_33\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_1' id='label_63_33_1' class='gform-field-label gform-field-label--type-inline'>Alpha House Inc.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.2' type='checkbox'  value='Big Brothers Big Sisters of Winnipeg'  id='choice_63_33_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_2' id='label_63_33_2' class='gform-field-label gform-field-label--type-inline'>Big Brothers Big Sisters of Winnipeg<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.3' type='checkbox'  value='Canadian Red Cross'  id='choice_63_33_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_3' id='label_63_33_3' class='gform-field-label gform-field-label--type-inline'>Canadian Red Cross<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.4' type='checkbox'  value='Community Respite Service'  id='choice_63_33_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_4' id='label_63_33_4' class='gform-field-label gform-field-label--type-inline'>Community Respite Service<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.5' type='checkbox'  value='Family Dynamics'  id='choice_63_33_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_5' id='label_63_33_5' class='gform-field-label gform-field-label--type-inline'>Family Dynamics<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.6' type='checkbox'  value='Harvest Manitoba'  id='choice_63_33_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_6' id='label_63_33_6' class='gform-field-label gform-field-label--type-inline'>Harvest Manitoba<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.7' type='checkbox'  value='Healthy Start for Mom &amp; Me'  id='choice_63_33_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_7' id='label_63_33_7' class='gform-field-label gform-field-label--type-inline'>Healthy Start for Mom &amp; Me<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.8' type='checkbox'  value='Immigrant &amp; Refugee Community Organization of Manitoba (IRCOM)'  id='choice_63_33_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_8' id='label_63_33_8' class='gform-field-label gform-field-label--type-inline'>Immigrant &amp; Refugee Community Organization of Manitoba (IRCOM)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.9' type='checkbox'  value='Ma Mawi Wi Chi Itata Centre'  id='choice_63_33_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_9' id='label_63_33_9' class='gform-field-label gform-field-label--type-inline'>Ma Mawi Wi Chi Itata Centre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.11' type='checkbox'  value='Manitoba Interfaith Immigration Council Inc. (Welcome Place)'  id='choice_63_33_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_11' id='label_63_33_11' class='gform-field-label gform-field-label--type-inline'>Manitoba Interfaith Immigration Council Inc. (Welcome Place)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.12' type='checkbox'  value='N.E.E.D.S. Inc.'  id='choice_63_33_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_12' id='label_63_33_12' class='gform-field-label gform-field-label--type-inline'>N.E.E.D.S. Inc.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.13' type='checkbox'  value='NorWest Co-op Community Health'  id='choice_63_33_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_13' id='label_63_33_13' class='gform-field-label gform-field-label--type-inline'>NorWest Co-op Community Health<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.14' type='checkbox'  value='Ronald McDonald House Charities Manitoba'  id='choice_63_33_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_14' id='label_63_33_14' class='gform-field-label gform-field-label--type-inline'>Ronald McDonald House Charities Manitoba<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.15' type='checkbox'  value='The Link (formerly Macdonald Youth Services)'  id='choice_63_33_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_15' id='label_63_33_15' class='gform-field-label gform-field-label--type-inline'>The Link (formerly Macdonald Youth Services)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_63_33_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.16' type='checkbox'  value='Winnipeg Christmas Cheer Board'  id='choice_63_33_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_63_33_16' id='label_63_33_16' class='gform-field-label gform-field-label--type-inline'>Winnipeg Christmas Cheer Board<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_63_33'>Note: Some requests can be expedited via a partner organization.<\/div><\/li><li id=\"field_63_14\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_14\" ><label class='gfield_label gform-field-label' for='input_63_14'>Is there any other information you would like to bring to our attention for consideration with this application?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_14' id='input_63_14' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_63_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_16\" ><label class='gfield_label gform-field-label' >Declaration: I declare that the information provided by me on this application form is accurate &amp; 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\u2019s Museum is discretionary.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_63_16'>\n\t\t\t<li class='gchoice gchoice_63_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='Yes'  id='choice_63_16_0'    \/>\n\t\t\t\t<label for='choice_63_16_0' id='label_63_16_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_63_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='No'  id='choice_63_16_1'    \/>\n\t\t\t\t<label for='choice_63_16_1' id='label_63_16_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_63_36\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_36\" ><label class='gfield_label gform-field-label' >Would you like to receive our monthly eNews updates?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_63_36'>\n\t\t\t<li class='gchoice gchoice_63_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='Yes'  id='choice_63_36_0'    \/>\n\t\t\t\t<label for='choice_63_36_0' id='label_63_36_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_63_36_1'>\n\t\t\t\t<input name='input_36' type='radio' value='No'  id='choice_63_36_1'    \/>\n\t\t\t\t<label for='choice_63_36_1' id='label_63_36_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_63_21\" class=\"gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_63_21\" ><label class='gfield_label gform-field-label screen-reader-text' for='input_63_21'><\/label><div id='input_63_21' class='ginput_container ginput_recaptcha' data-sitekey='6Lcy-OESAAAAALEE43bK5SY4zUGAK0XrkMoza2pC'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_63' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_63\"]){return false;}  if( !jQuery(\"#gform_63\")[0].checkValidity || jQuery(\"#gform_63\")[0].checkValidity()){window[\"gf_submitting_63\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_63\"]){return false;} if( !jQuery(\"#gform_63\")[0].checkValidity || jQuery(\"#gform_63\")[0].checkValidity()){window[\"gf_submitting_63\"]=true;}  jQuery(\"#gform_63\").trigger(\"submit\",[true]); 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