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VanPlay Stage Society Bursary Application Form
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Child's Name:
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Child's Birthday:
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Country of Residence:

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Country of Citizenship:

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Parent/Guardian Name (1):

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Gross Annual Income:

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Parent/Guardian Name (2):

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Gross Annual Income:

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Total Gross Annual Family Income:

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# of persons in household:

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Mailing Address:

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City: 

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Prov/State:

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Postal/ Zip Code: 

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Phone Number:

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E‐Mail:

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Student SIN or ITN:

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Student Pronouns:

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Which Performing Arts Program are you applying for funding to take part in?

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I certify that the information given is true and accurate.
Signature of Parent/Guardian or Participant (if 19 yrs or older) & date: 

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