Member Application Form

Member Application Form

Adult Learning Disability Member Application FormBelow, is our Member Application & Monitoring Form. If you or someone you know would like to apply for membership, please complete the Form.

An automatic email confirmation of the form will be sent to you, once completed. A membership fee does not need to be paid at this stage.

On receipt of the Application Form, we will telephone to arrange to meet, usually in the applicant’s home.  This is an opportunity to discuss what Supported Activities Programme is about and to answer any questions.  If membership is agreed, a £19 membership fee will need to be paid at this point.

Membership numbers are limited, therefore, at times, we may need to add an application to a waiting list. If this happens, you will be notified.

Member Application and Monitoring Form
Application Form
Drop a file here or click to upload Choose File
Maximum upload size: 67.11MB
The medical information, above, is essential for your safety. Any changes to medication or medical condition MUST be notified in writing to the Leisure Organiser prior to the next activity meeting. Leisure Direct cannot be held responsible for any incidents that result from undeclared medical conditions. ALL MEMBERS NEED TO BE SELF MEDICATING.
Monitoring Form
A carer may sign on behalf of a member if necessary)
Have you read our Code of Conduct?
All information given is covered by the Data Protection Act 1998