P.L.A.Y.
PROVIDING LEISURE ACCESS FOR YOU
FORM MUST BE COMPLETED IN FULL PRIOR TO THE ISSUING OF CARDS & COUPON BOOKS.
NAMES (First & Last)
AGE
BIRTH DATE
BC CARE CARD #
1.
2.
3.
4.
5.
6.
7.
8.
ADDRESS:
CITY/TOWN:
POSTAL CODE:
PHONE:
EMAIL:
You are eligible to receive PLAY discounts when your combined gross family income is below the following income:
National Council of Welfare Estimates of Stats Canada Low-Income Cut-offs 2014 Rates
# in Household
Income Under
1
$20,822
2
$25,921
3
$31,866
4
$38,691
5
$43,883
6
$49,493
7 & over
$55,103
ELIGIBILITY – All persons 19 years & older MUST provide Notice of Assessments from the previous tax year.
CHECKLIST – You MUST bring the following:
FOR OFFICE USE ONLY
Completed Application
Proof of Residency
BC Care cards for each family member
Photo ID (adults)
Income Tax Notice of Assessment (previous tax year)
Person with disability (PWD) verification
Don’t have your Notice of Assessment? Call Canada Revenue Agency at 1-800-959-8281.
What is acceptable proof of residency? Photo ID, rent receipt or utility bill in the name of the applicant.
What is PWD verification? – Bottom part of provincial cheque stub, BC ministry form, disability tax credit notice, CPP
disability income T4(A), BC Ferries PWD pass or BC Transit PWD pass.
PLAY Application
Page 2
ELIGIBILITY
Residents of Courtenay, Comox, Cumberland, Areas A, B, C of the Comox Valley Regional District.
The PLAY program is for individuals and families who are working low income, on BC benefits and/or the family income
before taxes does not exceed the amounts shown on the application form. Applicants must meet the annual income
requirements outlined on the application form.
APPLICATION PROCESS
Applications may be processed at either the Sports Centre, 3001 Vanier Drive or the Aquatic Centre, 377 Lerwick Rd.
You may bring your completed PLAY application, with supporting documentation, anytime during operating hours. A
customer service representative will verify your application and information, and forward to administration for processing.
You will then be phoned or emailed when your PLAY account has been activated, and you may pick up your cards and
coupons at the facility of your choice - please note that ALL family members must be present as PLAY cards include a
photo.
PLAY CARDS & COUPONS
Scan cards and program coupons are valid for the calendar year, and can be used at the CVRD Sports and Aquatic Centres.
Scan cards include 52 free facility admissions per year, per family member. Scan cards may be used by the person they
were issued to ONLY. Admissions do not include skate rentals for arena public programs. Program coupons will be issued
for each family member and include 1 free registered program and 4 programs at 50% off per calendar year. Program
coupons may be used for any registered programs, with the exception of Leadership Programs which MAY be included with
pre-approval by the Manager of Recreation Services – materials and supplies are the responsibility of the registrant.
USER PROCEDURE
Cards must be present and scanned in. Lost scan cards may be replaced for a fee. Full admission rates apply after the 52
free admissions are used. Cards are non-transferable, not for cash and not for credit. DO NOT destroy scan cards at end
of calendar year – these cards may be used for future years or any other regular priced membership. Program coupon book
must be presented at time of use. Individual coupons are not accepted. Program coupon books are not replaceable, nontransferable, not for cash and not for credit.
The Canadian Tire Jump Start Program may provide some funding to organizations.
_____ Yes; I give permission to the CVRD Sports and Aquatic Centres to release my child’s name, city of residence, age, gender,
and activity registered in, to the Canadian Tire Jump Start program. I understand that this information is to be used by Jump
Start for verification of program registration only.
_____ No; I do not give permission to the CVRD Sports and Aquatic Centres to release my child’s name, age, birth date, phone
number and city of residence to the Canadian Tire Jump Start program.
I ____________________________(print name) agree to meet with a representative of the CVRD Sports and Aquatic Centres
and will at that time disclose financial information based on my latest Revenue Canada tax return.
_____________________________________________________
Signature
I wish to pick up my cards/coupons at the (circle one) Sports Centre
_________________________________________
Date
or
Aquatic Centre.
FOR OFFICE USE ONLY: Processed ___________________________ Date _________________________________