Nominations
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Nominations
About
Photos
Videos
Contact
Helping Kids Play
Live in the Comox Valley and need equipment to play?
... let us help you!
Let us know what you need to be active and play!
*
Indicates required field
Your Name
*
First
Last
You full name.
Email
*
An email address we can contact you at.
Phone Number
*
A phone number we can contact you at.
Child's Name
*
First
Last
Usage
*
Personal / Home Usage
Organization / Club Usage
School Usage
Please let us know how you will use this equipment.
Child's Age
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Please enter either your address of the business address this donation is on behalf of.
Tell us what you need and why!
*
Let us know if you have any specific requests or instruction along with your donation.
Agreement of Submission
*
Yes, I have read the Rules and Regulations
Submit
Rules and Regulations