Application for Assistance

Please fill out the form below and submit for consideration. You will also need to send/email us a doctors note confirming the diagnosis (1 page max pls) as well as at least one quote for the item/camp/therapy you are requesting. ALL REQUIRED DOCUMENTS MUST BE SUBMITTED BEFORE YOUR APPLICATION WILL BE CONSIDERED. 

 
Do you receive special services at home? Do you receive ADSC (Assistance to Children with Severe Disabilities) Do you have Extended Health Benefits through your Employer?
YES NO
YES NO
YES NO

I certify that the information in this form is true and complete and does not contain a claim for any expenses previously paid for by this or any other organization. I authorize For the Love Of a Child, it's Agents and Service Providers to use and exchange information needed for approving this request.

I AGREE

As you are aware, For the Love of a Child is a non-profit organization that depends on volunteers. Would you be willing to volunteer for our organization?

YES NO

For the Love of a Child...

For The Love of A Child is a charitable organization helping kids in Durham Region, Ontario, dedicated to improving the lives of children with special needs and their families. Having a child with special needs changes a person's life forever.

The mental, physical, and financial strain can devastate families.

The goal of this organization is to alleviate some of the financial burden , and make a difference in the life of a child.