Over 12's Membership Form

Please fill out this form as best you can so we can provide you with the most relevant service. Version 1 March 2022 YOU MUST COMPLETE A MEMBERSHIP FORM FOR EACH OF YOUR SERVICE USER GDPR Statement We promise to: - Only collect information that we need for the specific purpose of The Social Action Hub activities - Ensure your information is relevant and update by contacting you regularly to update your details - Only hold as much information as we need and only keep it for as long as we need it - Allow you to see the information that we hold about you on request - Keep your information secure and never share it with third parties without your permission

House Number and Street Name

Gender

Male

Female

Non Specific/Gender Fluid

Emergency Contact Number

Emergency Contact Name

Household Situation. Please select as many as apply

No household member is in employment

My household include sone or more dependent child

I live in a single adult household with dependent children

My household is classed as 'low income' /receives certain benefits/state pension/free school meals

My household includes a person with a disability, learning difficulty or health condition

I live alone

None of these statements apply

Please provide details of your condition, any support needs and any medication that you may need to access during services

Name School Attended

GDPR Statement

The Social Action Hub is committed to protecting and respecting your privacy.

We promise to:

- Only collect information that we need for the specific purpose of The Social Action Hub activities

- Ensure your information is relevant and update by contacting you regularly to update your details

- Only hold as much information as we need and only keep it for as long as we need it-

- Allow you to see the information that we hold about you on request

- Keep your information secure and never share it with third parties without your permission

Please check the box below to confirm you consent to us using your data this way.

You can unsubscribe from these communications at any time. For more information on how to unsubscribe, our privacy practices, and how we are committed to protecting and respecting your privacy, please review our Privacy Policy HERE.

By clicking submit below, you consent to allow The Social Action Hub to store and process the personal information submitted above to provide you the content requested.

I want to subscribe to the mailing list

I agree to my/my child's photos being shared for promotion purposes

I have read and understood the GDPR statement and consent to my data being used for the purposes of evaluating services. I know how to subscribe should I wish to.

I agree to trained and experienced staff administering first aid and/or medication

I agree to my/my child's photos being shared for promotion purposes

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