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Family Information
Please complete the registration below.
Submission failed due to the following error(s). Please click on the error to bring you to that spot in the application:
Legal Name
: Enter your family last name below for Legal Name.
*
Legal Name
*
City
--- Select One ---
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
*
Province or Territory
*
Postal Code
Parent/Guardian Information
Parent/Guardian #1
u1_
First Name and Last Name that appears on government-issued Canada child benefit (CCB) notice.
*
First Name
*
Last Name
*
Email
*
Confirm Email
*
Phone Number
*
Preferred language
Please Select
English
French
Child Information
Child #1
u2_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Child #2
Remove Child
u3_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Child #3
Remove Child
u4_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Child #4
Remove Child
u5_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Child #5
Remove Child
u6_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Child #6
Remove Child
u7_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Child #7
Remove Child
u8_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Child #8
Remove Child
u9_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Child #9
Remove Child
u10_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Child #10
Remove Child
u11_
*
First Name
*
Last Name
*
Date of Birth
The age must be between 4 and 18.
Once you select the year of birth, click on the actual day in the calendar to select the right Date of Birth.
*
Gender
Please Select
Agender
Genderfluid
Man/Boy
Non-Binary
Transgender
Two-Spirit
Woman/Girl
A gender not listed here
Prefer Not to Say
Please add all children in your family even if you wish to only complete an application request for one child at this time.
Canadian Tire Jumpstart Charities (Jumpstart) is committed to protecting the privacy and security of all personal information obtained while fulfilling its mandate.
Please visit the Jumpstart website to review our Privacy Policy.
Add Child