To¬†apply for assistance, either for¬†yourself or on someone’s behalf, please fill in our application below.

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I/we consent to Second Chance Kids collecting the information I/we have provided on this form for the purpose of assessing and verifying my/our eligibility to receive funding.

I/we understand that in receiving funding from Second Chance Kids all monies will be used only for costs associated in supporting our child at a health care facility outside of Grey-Bruce region for primary medical care. I/we understand these costs may include, but are not limited to, shelter, transportation expenses, parking, and food for my/our child and the caregiver(s). I/we agree to retain all receipts for audit purposes and shall produce same to Second Chance Kids at any time upon request.