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Personal Assistant for Leisure Activities Card Application
The personal assistant for leisure activities card service is designed to facilitate the involvement of people with a disability in municipal programs and services. With an approved card, your personal attendant is admitted at no charge and is present for the sole purpose of assisting you to participate. The card is accepted by many municipalities in KW and surrounding area.
Please provide the first and last name of the applicant
Please provide a phone number for the applicant
Please provide an email address for the applicant
Please provide the street address for the applicant
City
Please provide a postal code
Applicants must be a minimum of 4 years old. Does the applicant meet this requirement?
Yes
No
Date of birth of the applicant
Sex/Gender
Female
Male
Other
Are you completing this form on behalf of someone else? Support worker, parent etc.
Yes
No
Is the disability permanent or temporary?
Permanent
Temporary
Has the disability lasted longer than six months?
Yes
No
Is the disability eliminated by the use of an assistive device? (such as glasses)
Yes
No
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