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Family Information

Please complete the registration below.
Legal Name: Enter your family last name below for Legal Name.

Parent/Guardian Information

Parent/Guardian #1

First Name and Last Name that appears on government-issued Canada child benefit (CCB) notice.

Child Information

Child #1

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.
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.