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Account Holder Information
Member's Personal Details
Address Information

Account Holder Information

Email * The Account Holder must be an adult over 18 years old who will be contacted in the event of an emergency.

Title *

First Name *

Last Name *

Phone *

Mobile *

Member's Details

Date of Birth *

Age
Years

Member's First Name *

Member's Last Name *

Gender *

Email *

Phone *

Mobile *

Preferred Communication

Occasionally we would like to send you information about a change in the programme, new activities that might be of interest to you, or ask for your help with a short survey to find out if we are providing what our members want.

Address Information

Address Line 1 *

Address Line 2

City *

Country *

Postcode *

Ward

Borough

Emergency Contact details

Use Member’s Address

Name of Parent / Guardian *

GuardianPhone *

Email *

Relationship to Member *

Email 2

Address *

Comments

Medical Condition *

Allergies / Dietary Requirements *

Photography/Film Consent Given *

I understand that photographs, audio and visual recordings of the participant engaged in St Andrew's Club activities may be used for promotional or other materials, such as websites, local and national media. All rights to the photographs or recordings and all recordings belong to St Andrew's Club. Please read our Photography & Film Consent Policy (hyperlink to download) and click on Yes or No regarding your own consent or consent for your child if they are under 18.

Additional Information

As a registered charity we rely on voluntary donations. The following information will help us with our funding applications and will be anonymised for analysis.

Learning Difficulties

Disability

Accommodation Status

Ethnicity

Education Status

Name of School

Are you in full time employment

Employer

Religion

Is your family in receipt of free school meals?