Power Soccer Guard Loan Application

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Please fill out the following application for the SportAbility Power Soccer Loan Program. In order to be eligible to apply for SportAbility power soccer equipment, you must be:
- An active participant in a SportAbility program, or
- An active participant in a SportAbility partnership program, or
- Reside in a BC region where there is no regular power soccer programs

You must also:
- Be a resident of BC
- Be a member in good standing with SportAbility
- And show a substantial need for power soccer equipment.

Filling out this form does not guarantee you will receive the requested equipment. Equipment rentals depend on amount of equipment available etc.

Name *

Phone Number *

Address *

City and Province *

Postal Code *

Email Address *

Birth date *

YYYY

Disability (if applicable) *

I intend to play Power Soccer in the following situations for the current or upcoming season: *

Please check all that apply

City of Surrey Power Soccer Program

Vancouver Power Soccer Program

Nanaimo Power Soccer Program

Okanagan Power Soccer Program

Chilliwack Power Soccer After School Program

City of Maple Ridge Junior Program

School Program

Play in an area of BC without a regular program

Required

Are you a member in good standing with SportAbility? *

If not, please complete a membership form along with the appropriate payment amount.

Yes

Are you planning to reside in BC for the next year? *

Yes

Please provide a brief history of your participation in power soccer and the number of years that you have been playing in BC. *

Please describe why you need to rent our power soccer equipment. Also indicate, if applicable, the type and condition of the equipment you currently use to participate. *

Do you have the ability to access funds to purchase a power soccer guard from other sources or agencies? *

Yes

If yes, are you currently pursuing a new guard and what is the status of your request? If no, explain why not. *

What equipment do you require? *

Please select all that apply

Metal Foot Guard

Plastic Foot Guard

Soccer Ball

Required

Successful applicants/renewals must sign a Power Soccer Loan Agreement that is one year in length.

Signature *

Date *

YYYY

Signature of parent or guardian (if participant is under 18 years of age)

Date

YYYY

Submit

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