Amazing Kids Intiative
AKC-“100 Kids A Year” Enrollment Application

Thank you for your interest in ‘100 Kids A Year’ initiative Program in partnership with Amazing Kids Clinic. While Amazing Kids Clinic is obligated to collect payments for all of our services, those in financial need may be eligible for co-pay or other financial assistance in accessing pediatric therapy. This is made possible through the ‘100 Kids A Year’ initiative to assist current patients of Amazing Kids Clinic with proven financial need.

To apply for this program, please follow the steps listed below:
1. Complete the attached Enrollment Application – Your signature is required to complete the application.
2. Submit copies of current financial documents
3. Submit copies of your insurance information (if there’s any)
4. Submit a copy of your child’s most recent evaluation. If you do not have a recent evaluation, we welcome
you to reach out to Amazing Kids Clinic to set one up. We will not be able to process your application
without a complete evaluation. The number to call 647-984-4865.
5. Fax or mail us the completed and signed form with supporting documents to:
a) The Amazing Kids Clinic-   3331 Markham Rd Unit 105, Scarborough, ON M1X 1S8
b) Fax: 1-800-974-4069 – Attn: The Amazing Kids Clinic “100 Kids A Year”

The application will be evaluated and processed in order to assist your needs and an acceptance or denial status will be determined. Approval depends on the correct and complete enrollment information on the application, financial need and the funds available through ‘100 Kids A Year’ initiative. Criteria for eligibility can be obtained by contacting us at- info@amazingkidsclinic.com

We look forward to receiving your application.

Sincerely,
The Amazing Kids Clinic