Required fields are marked with asterisks (*)

PAL card application

The PAL card program allows individuals with a disability to be accompanied by a personal attendant so that they may have the help they need to participate in recreation and leisure programs and services offered by the municipality and PAL card partners. The personal attendant is not charged the program fee and is present for the sole purpose of assisting the person with the disability. The regular program/registration fee is charged to the person with the disability.

Applicant needs to be a minimum of 4 years old to apply.

The PAL card is accepted by many municipal programs in K-W and surrounding area. For a full listing of locations please visit www.kitchener.ca/PAL.

First name (person with the disability)

Last name (person with the disability)

Date of birth (person with the disability)

Gender identity (person with the disability)

Home phone number

Cell phone number

Email address (person with the disability)

Apartment or unit

Applicant's home address

City

Postal code

Is the person with the disability 17 years old or younger?

Yes, they are 17 years old or younger

No, they are 18 years old or older

Is the address for the person with the disability and the parent/caregiver the same?

Yes, the address is the same.

No, the addresses are different.

To determine eligibility, please answer the following questions.

Notice of collection

The personal information collected in this application will only be used for purposes relating to the program and will be protected in accordance with the requirements stipulated in the Municipal Freedom of Information and Protection Privacy Act (MFIPPA).

For inquiries about the collection of your personal information please contact 519-741-2200, ext. 7623 or TTY 1-866-969-9994.

Land acknowledgement

The City of Kitchener is situated on the traditional territory of the Chonnonton, Anishinaabeg, and Haudenosaunee Peoples. We recognize our responsibility to act as stewards for the land and honour the original caretakers who came before us. Our community is enriched by the enduring knowledge and deep-rooted traditions of the diverse First Nations, Métis, and Inuit Peoples who live in Kitchener today.