FAIR Play Program Application
What is the FAIR Play Program?
The FAIR Play (Financial Access and Inclusion for Residents) program provides eligible Burnaby residents in financial need an annual Be Active Pass, and a credit on their account to be used at any
Burnaby Parks, Recreation and Culture facility for activity registration. The FAIR Play Program pass and credit have no cash value and are valid for one year. You must complete the application process each
year. If you have questions about FAIR Play, or to confirm the start or expiry of your credit, contact any Burnaby recreation or culture facility.
SECTION A: Proof of Burnaby Residency (Required for all applications): SECTION C: List all family members, starting with the applicant.
I am a resident of Burnaby (proof of residency attached) Family is defined as a single adult or two legally married/common-law adults, and their legal dependents aged 18
(See reverse for details) years and younger living in the same home. Extended family or children over the age of 18 years living in the same
home must apply separately.
SECTION B: Method of Application (Choose One) Last Name First Name (Preferred Name) Birthdate (mm/dd/yyyy)
1. Receiving Income Assistance (see #1 on reverse)
1.
Copy of confirmation of income assistance attached
2.
Copy current Child Tax Benefit Notice attached
(If application includes children)
3.
2. Family Income (see #2 on reverse for eligible amounts)
4.
Copy current Child Tax Benefit Notice attached
(If application includes children) 5.
Copy of Proof of Income Statement
(for all adults) 6.
Combined Family Income
Total income from line 15000 of most recent $ 7.
Proof of Income Statement(s) (for all income earners in the family)
8.
3. Child with Disability (see #3 on reverse)
Copy of current Canada Child Tax Benefit Notice attached
Address: City:
4. Government or Privately Sponsored Refugee (see reverse) Postal Code: Home Phone: Cell Phone:
Copy of Verification of Status document attached
Applicants are eligible to use this category once. E-mail:
Copy of your Confirmation of Permanent Residence/Permanent If translator required: Name: Phone:
Resident Card for each applicant. Please Print
FAIR Play office: Phone: 604-320-2227 | Email:
I certify that all the information given on this form is current, complete and fully discloses my family income.
Applicant Signature: Date:
Burnaby Parks, Recreation and Culture reserves the right to refuse access to this program to anyone who provides false information. In the event that Burnaby Parks, Recreation and Culture discovers any false information after an application has been
approved, Burnaby Parks, Recreation and Culture reserves the right to nullify a pass, and withdraw clients from any courses that they have registered for at a reduced rate.
The personal information collected on this form is authorized under section 26 (C) of the Freedom of Information and Protection of Privacy Act for the purpose(s) set out on this form. Should you have any questions about the collection of this personal
information please contact us by mail by: Park, Recreation & Culture | #2301-3713 Kensington Ave., Burnaby, B.C. V7B 0A7, by telephone: 604-294-7450 or by email: .
October 2025 1
What is the FAIR Play Program?
The FAIR Play (Financial Access and Inclusion for Residents) program provides eligible Burnaby residents in financial need an annual Be Active Pass, and a credit on their account to be used at any
Burnaby Parks, Recreation and Culture facility for activity registration. The FAIR Play Program pass and credit have no cash value and are valid for one year. You must complete the application process each
year. If you have questions about FAIR Play, or to confirm the start or expiry of your credit, contact any Burnaby recreation or culture facility.
SECTION A: Proof of Burnaby Residency (Required for all applications): SECTION C: List all family members, starting with the applicant.
I am a resident of Burnaby (proof of residency attached) Family is defined as a single adult or two legally married/common-law adults, and their legal dependents aged 18
(See reverse for details) years and younger living in the same home. Extended family or children over the age of 18 years living in the same
home must apply separately.
SECTION B: Method of Application (Choose One) Last Name First Name (Preferred Name) Birthdate (mm/dd/yyyy)
1. Receiving Income Assistance (see #1 on reverse)
1.
Copy of confirmation of income assistance attached
2.
Copy current Child Tax Benefit Notice attached
(If application includes children)
3.
2. Family Income (see #2 on reverse for eligible amounts)
4.
Copy current Child Tax Benefit Notice attached
(If application includes children) 5.
Copy of Proof of Income Statement
(for all adults) 6.
Combined Family Income
Total income from line 15000 of most recent $ 7.
Proof of Income Statement(s) (for all income earners in the family)
8.
3. Child with Disability (see #3 on reverse)
Copy of current Canada Child Tax Benefit Notice attached
Address: City:
4. Government or Privately Sponsored Refugee (see reverse) Postal Code: Home Phone: Cell Phone:
Copy of Verification of Status document attached
Applicants are eligible to use this category once. E-mail:
Copy of your Confirmation of Permanent Residence/Permanent If translator required: Name: Phone:
Resident Card for each applicant. Please Print
FAIR Play office: Phone: 604-320-2227 | Email:
I certify that all the information given on this form is current, complete and fully discloses my family income.
Applicant Signature: Date:
Burnaby Parks, Recreation and Culture reserves the right to refuse access to this program to anyone who provides false information. In the event that Burnaby Parks, Recreation and Culture discovers any false information after an application has been
approved, Burnaby Parks, Recreation and Culture reserves the right to nullify a pass, and withdraw clients from any courses that they have registered for at a reduced rate.
The personal information collected on this form is authorized under section 26 (C) of the Freedom of Information and Protection of Privacy Act for the purpose(s) set out on this form. Should you have any questions about the collection of this personal
information please contact us by mail by: Park, Recreation & Culture | #2301-3713 Kensington Ave., Burnaby, B.C. V7B 0A7, by telephone: 604-294-7450 or by email: .
October 2025 1
