Required fields are marked with asterisks (*)

Leisure Access (fee assistance) application - 2026

Leisure Access offers financial support for residents with low income living in Kitchener to help them participate in recreational programs.

Main contact information

First name

Last name

Date of birth:

House number and street

Apt/Unit

City:

Postal code:

Telephone number

Cell number

Email address:

Re-enter email address

Number of people in your family unit

Emergency Contact

To create or update your ActiveNet account an emergency contact is required. The emergency contact is only contacted if we cannot reach the primary household contact (e.g. parent or guardian) that we already have on file. It is recommended that your emergency contact should NOT be a contact within the same household, but rather an alternate contact in the local area.

First name (emergency contact)

Last name (emergency contact)

Relation (emergency contact)

Phone (emergency contact)