Members Form
Identity
Surname
Forename
Also Known As
DateOfBirth
Day
1st
2nd
3rd
4th
5th
6th
7th
8th
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Month
January
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Year
2036
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1914
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1912
1911
1910
School
Contact
Mobile
Email
Address
Address1
Address2
Town
County
Post Code
Demographic
Gender
Please Select
Female
Male
Transsexual Female
Transsexual Male
Non-binary
Prefer not to say
Unknown
Ethnicity
Please Select
Asian/Asian British - Bangladeshi
Asian/Asian British - Chinese
Asian/Asian British - Indian
Asian/Asian British - Pakistani
Asian/Asian British - Other
Asian/Asian British - Unspecified
Black/African/Caribbean/Black British - African
Black/African/Caribbean/Black British - Caribbean
Black/African/Caribbean/Black British - Other
Black/African/Caribbean/Black British - Unspecified
Mixed/multiple ethnic groups - White and Asian
Mixed/multiple ethnic groups - White and Black African
Mixed/multiple ethnic groups - White and Black Caribbean
Mixed/multiple ethnic groups - Other
Mixed/multiple ethnic groups - Unspecified
White - Welsh/English/Scottish/Northern Irish/British
White - Irish
White - Eastern European
White - Gypsy, Roma or Irish Traveller
White - Other
White - Unspecified
Other ethnic group - Arab
Other ethnic group - Other
Prefer not to say
Unknown
Disability
Please Select
Yes
No
Prefer not to say
Unknown
Disability - please specify
Autistic Spectrum Disorder or Asperger Syndrome
Blind or partially sighted
Complex disabilities
Deaf or hearing impairment
Emotional/behavioural difficulties
Mental health difficulties
Multiple disabilities
Temporary disability after illness or accident
Unseen disability (e.g. diabetes, epilepsy, heart condition)
Wheelchair user or mobility difficulties
Prefer not to say
Unknown
Household receives Universal Credit
Please Select
Yes
No
Next of Kin / Parent / Guardian Information
First name
Last name
Email
Mobile
Relationship to participant
Secondary Contact
Name
Mobile
Email
Relationship
Medical
Medical notes
SEND / additional support needs
Please Select
Yes
No
Data Protection & Use
Data Protection & Use
I agree for you to use my data for legal reasons associated with the running of your club
I agree for you to use my data so that you can provide me with your club's services
I agree for you to use my data so that I can receive benefits as part of my membership, including occasional marketing info.
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