Membership and Subscription We are a registered charity and as such rely on funding in the form of grants and donations. Subscriptions are a contribution towards the administration of the Club. Membership subscriptions are made every three months (quarterly) by standing order on the 1st Jan, 1st April, 1st July and 1st Oct. Membership is open to children with special needs and their families who live in the local authority areas of Bristol or South Gloucestershire. The quarterly subscription rate of £21 applies to each disabled child or young person and each sibling in the family that you want on your membership so that they can come along to activities. There is no need to pay for any child under the age of 3. We offer a reduced rate of £15 per disabled child/young person/sibling for families on a low income. The questions below, alongside the evidence you send, will help the Trustees build a picture of your child’s needs and help us decide whether Special Friends Club is suitable for your family. Please send copies of clinic letters, doctor’s reports or EHCP as evidence of your child or young person’s disability from at least 2 professionals to: admin@specialfriendsclub.org.uk or by post to SFC, 13 Banner Road, Montpelier, Bristol BS6 5NA.Family informationParent/Carer First and Last Names(Required)Mobile numberEmail(Required) Address Line 1(Required)Address Line 2Town/City(Required)Post code(Required)County(Required) Bristol South Gloucestershire How did you hear about Special Friends Club?(Required)Child 1First name(Required)Surname(Required)Date of birth(Required) DD dash MM dash YYYY Disability(Required)Gender(Required) Male Female Other Prefer not to say Child 2First nameSurnameDate of birth DD dash MM dash YYYY DisabilityGender Male Female Other Prefer not to say Child 3First nameSurnameDate of birth DD dash MM dash YYYY DisabilityGender Male Female Other Prefer not to say Child 4First nameSurnameDate of birth DD dash MM dash YYYY DisabilityGender Male Female Other Prefer not to say Additional Children you wish to be included on your membershipName, Date of Birth, Disability and Gender for any additional childrenAdditional needsDoes your child/young person receive DLA/PIP?(Required) Yes No What rate do they receive for care/daily living?(Required)What rate do they receive for mobility?(Required)How does your child's condition impact on their ability to be able to attend mainstream activities?(Required)Does your child or young person have an EHCP or do they receive extra support at school (please specify)?(Required)Does your child or young person attend a specialist school or college provision or attend a mainstream nursery or school (please specify)?(Required)MembershipPart of our funding is provided by South Gloucestershire Council Short Breaks, Children In Need, National Lottery Community Fund and other grant organisations. The conditions of these grants are that we report data to each organisation about who has attended an activity, giving anonymised information such as their age, local authority area and any disability.(Required)To join Special Friends Club please confirm that you agree to the above details being passed onto our funding organisations for planning and funding purposes. Yes Do you consent to your family’s contact details to be held by SFC on our secure database for administration purposes (details will not be revealed to third parties).(Required)It will not be possible for us to approve your application without this consent as it would prevent us from running the Club. Yes Do you consent to photographs of your family being used for publicity purposes by SFC. No names will be used. For example on our website, in our annual report or grant applications.(Required) Yes No Please specify your ethnicity (this is used for funding purposes).(Required)Asian/Asian British – BangladeshiAsian/Asian British – IndianAsian/Asian British – PakistaniAsian/Asian British – ChineseAsian/Asian British – OtherBlack/African/Caribbean/Black British – AfricanBlack/African/Caribbean/Black British – CaribbeanBlack/African/Caribbean/Black British – OtherMixed/Multiple Ethnic Groups – White & AsianMixed/Multiple Ethnic Groups – White & Black AfricanMixed/Multiple Ethnic Groups – White & Black CaribbeanMixed/Multiple Ethnic Groups – OtherWhite – English/Welsh/Scottish/Northern Irish/BritishWhite – IrishWhite – Gypsy or Irish TravellerWhite – OtherOther Ethnic Group – ArabAny Other ethnic groupDeclarationI understand and accept that the supervision and safety of my children is the responsibility of my family at all times during Club activities.(Required)Please sign and date in the box below:Date(Required) DD dash MM dash YYYY Δ
