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.

Is the person with the disability 17 years old or younger?
 
Is the address for the person with the disability and the parent/caregiver the same?
 

To determine eligibility, please answer the following questions.

Is the disability permanent or temporary?
Has the disability lasted longer than six months?
Is the disability eliminated by use of an assistive device? (such as eye glasses)

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.