IM2C Adult Services - Registration Form

IM2C Adult Services - Registration Form

For Adult Services from age 18yrs+
Please view our range of activities and services on our Website Page

https://www.includeme2club.org.uk/adult

Find, Like and Follow our Children's Services Facebook page for regular information, group times and updates

https://www.facebook.com/IM2CAdults
Your or Your Dependants Name*
Are you an existing member of Include Me 2 Club SCIO?

YesNoUnsure
Please identify which service(s) you are interested in registering your child for:

Social ClubBuddy ClubDance ClubWell WalksConnect ClubConnect Club Plus (50yrs+)Fishing GroupClub Late/Live LateBuddy UpSocial BlendVolunteeringOther
Please identify which service(s) you are interested in registering for:

BarrheadRutherglenFernhillCardonaldHaghillNeilstonCity CentreGiffnockOther
Please select a specific service if you know about it are registering for a specific session
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
Age
Date of Birth

MonthDayYear
Date
Emergency Contact Name*
Emergency Relation to you/them?*
Emergency Contact Number*
Emergency Contact No.*
Do you or your dependant have any additional support, disabilities or learning needs? If so could you provide us with details to help us best support you/them during their activities with us?
Do you or your dependant have any dietary restrictions or any medical conditions we should be aware of like allergies, hay-fever, asthma, diabetes, epilepsy etc.
Would you like to speak with our Adult Services Team about you or your dependants needs and access to activities before attending?

YesNo
Do we have permission to take photographs/videos of you or your dependant during the club activities and events?

Yes, these can be used for social media posts/promotion of the clubYes, but not to be shared on social media posts/to promote the clubNo I do not give permission for any photgraphs/videos to be takenOther
Do you have any questions about registration, accessing or attending any of our activities?
Is there any specific hopes, aims or goals you would like to see happen from attending IM2C activities?

Make New FriendsHave FunConnect with my CommunityAchieve an AwardTry New ActivitiesTake part with my Peer GroupOther
Data Protection

Your data will be held securely in accordance with current GDPR Legislation and guidance. IM2C will not share, sell, loan or your data. It will only be shared in the event of an emergency or medical emergency with trusted officials/bodies such as NHS and Police etc. Your data will be held securely on our CRM System/UpShot and communications will be kept to a minimum. You can opt of any updates and communications at any stage.
Should be Empty:

IM2C Adult Services - Registration Form

Data Protection