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Apply for My CAL

Before you start…

To apply for your CAL, make sure you have:

Your proof of eligibility or Sections D and E;
A photo of your face

Visit the Prepare My Application section to get all the necessary information.

Submit a New Application

For renewals

Visit this page to view the procedure.

Renew my CAL

Lost, stolen or not received card?

You must complete this form.

Report a lost, stolen, or not Received CAL

Step 1 - Information About the Cardholder

The cardholder is the person with a disability who requires support to carry out daily activities. Please provide the personal information of the cardholder below.

” * ” required fields

First name *

Last name *

Address (Number, street) *

Apartment

City *

Province *

Postal code *

Region *

Home phone *

Office phone

Cell phone

Gender *

Female
Male
Other

Email address *

Date of birth (YYYY-MM-DD) *

Language of correspondance *

English
French

Reason for the need for support : *

See the section on support needs for more information. Please check the one or more that apply to you

To communicate with others
To complete the activity safely
To help you with your personal needs
To feed yourself
To move about
To orient yourself

If applicable, indicate any other relevant information concerning your support needs:

Photo *

Please make sure that your photo matches all the following criteria:

The submitted photo must be of the cardholder (the person with a disability).
Required format: JPEG
Minimum dimensions: 50 mm wide by 70 mm high (2 inches wide by 2¾ inches high)
Ideal resolution: 72 dpi
A photo from the shoulders to the top of the head with the face centered is required.
The photo must have been taken within the last 6 months.
The photo and background must be clear (unobstructed face, no glare on glasses, no hats, no backlighting).
Black and white or color photos are accepted.
Photos taken with a cellphone are accepted.

Step 2 – Information About the Representative

First name

Last name

Home phone

Work phone

Cell phone

Email address

Relationship to the disabled person

Father / Mother
Spouse / Partner
Trustee
Guardian
Other

Details (other)

Name of your organization (center, institution, organization)

Step 3 – Proof of Eligibility

Please check the appropriate box

“I have a proof of eligibility” if you have a document from our list. We invite you to consult the Provide Proof of Eligibility page to view the list.
“I do not have a proof of eligibility” if you do not have any document from our list. In this case, by selecting “I do not have a proof of eligibility,” Section D will appear for you to complete, and you will be able to print and have Section E completed by a health and/or social services professional from our list, then upload the document in the required field.

Sections D–E of the form are available at the following link if needed: Section D and E of the CAL form

Please check the statement that applies *

I have proof of eligibility
attach it in a PDF format
I do not have proof of eligibility
fill in the section
D. Authorization to disclose personal information for verification with a worker in the health and social services network
and attach a scanned file of the section
E. Certification by a health or social services worker
Téléchargez la partie E du formulaire ici.

File for your proof of eligibility *

Authorization to disclose personal information for verification with a worker in the health and social services network - To be completed if you do not have proof of eligibility

Worker's first name *

Worker's last name *

Applicant's first name *

Applicant's last name *

Date of birth (YYYY-MM-DD) *

Signature *

I authorize the health worker, whose name appears above, to confirm the information provided in section A for the sole purpose of accessing the CAL.

Date (YYYY-MM-DD) *

Certification by a health or social services worker - To be completed if you do not have proof of eligibility

Scanned file of Section E *

Step 4 – Commitment and signature of the Applicant

If I obtain the Companion leisure Card, I undertake to:

present the card to partner organizations that recognize it;
choose a person who is able to act as an accompanying party and meet my needs for a safe and proper conduct of the activity;
inform the AQLPH of any change in coordinates, or if ma card is lost, stolen or broken;
comply with the prohibition to lend the card to another person.

Signature *

I certify that the information I have provided to determine my eligibility for the card is accurate.

Government programs and measures recognized for eligibility purposes

You will obtain the Accompagnement loisir card if:

you are a recipient of one of the following government programs and measures;
and that you are able to provide evidence to support it.

Please check the statement that applies *

Special Needs Allowance Program for study (Adult) - Accompaniment services provided
If you have any support provided as part of vocational training, adult education, college, university, please attach the calculation statement, taking care to censor all personal information, except your name and the form of support received.
Supplement for a handicapped child (Retirement Québec)
If the supplement for a disabled child is granted to your child, please attach the letter from Retraite Québec confirming this.
Canada child benefit (Canada Revenue Agency)
If the Canada child benefit is granted to your child, please attach the letter confirming this.
Amount for severe and prolonged impairment in mental or physical functions (Revenu Québec)
If you are eligible for the tax credit for severe and prolonged impairment in mental or physical functions, please attach the notice of assessment demonstrating your eligibility (line 376), censoring all other information except your name, date of birth and home address.
Disability amount (Canada Revenue Agency)
If you are eligible for the disability tax credit, please attach the Canada Revenue Agency’s notice of determination confirming it.

Supporting document *

PDF format required.

Accompanying card recognized for eligibility purposes

You will obtain the Accompagnement loisir card if:

you already hold one of the following accompanying cards that required a professional assessment of your support needs;
and are able to attach a photocopy.

Please check the statement that applies *

The Quebec accompaniment card for intercity coach transportation (Fédération des transporteurs par autobus)
The STM accompanying card (Société de transport de Montréal)
CNIB identification Card

Supporting document *

PDF format required.

Step 5 - Additional information

This section of the form is optional. This information will remain confidential and used only for a better understanding of user profiles by diagnosis, in order to provide you with better services.

Autism Spectrum Disorder
Hearing disability
Intellectual disability
Language disability
Other
Physical / motor disability
Visual disability

Main disability (other)

Protection of personal information

The personal information collected is necessary to study your request. Only relevant staff within the AQLPH can access it.

This card is issued by the Association québécoise pour le loisir des personnes handicapées (AQLPH), with the support of the regional authorities responsible for the recreation of persons with disabilities and the financial participation of the Government of Quebec.

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