Hertford Men's Shed Membership request form

Hertford Men's Shed Membership Request Form

For all new membership inquiries, please fill out the form below. Your personal information and data will be added to our online member database and kept confidential under our Privacy Policy
Full Name:

First NameLast Name
Phone number

Your preferred phone numberOptional - other phone number / home phone
Would you like to be added to our WhatsApp group - this helps to keep you in the loop with whats going on at the shed ?
Email contact:
Date of birth (please state as xx/xx/xxxx):
Please select your ethnicity
Your postcode:
I am interested in being a part of the Hertford Men Shed Committee/ Development group?
Medical conditions - Please detail any medical conditions, allergies or medication you would like to inform us about. We require this information for our risk assessments, to ensure we are prepared in case of emergency and to ensure the Shed operates safely.
Please state any medical details of which we should be aware of in case of emergency Eg - diabetes, epilepsy, epi pen/ asthma inhaler
Do you require any reasonable adjustments to access the Shed? This may be a ramp, special seating etc ?
Do you have a physical or mental health condition lasting longer than 12 months ?
If you answered Yes to the above - how does this condition limit your day to day activities?
Would you be interested in attending a Men Shed members only, chair yoga/ seated exercise class if we had enough interest from members ?
Emergency contact 1 - details

Name/ relationship to you Contact phone number in case of emergency
Emergency contact 2- details

Name/ relationship to you Contact phone number in case of emergency
Doctors Surgery
Please tick what sessions your are interested in
We are thinking of launching a monthly weekend session, what day would be your preference, please tick all that apply?
Please tick what Men Shed activities you are interested in ...
Interests & Skills - Please provide us with a summary of your interests/ skills that you may like to bring to Hertford Men's Shed
How did you find out about the Shed? Eg Facebook, word of mouth, Doctor, Referral, Event...
Declaration
£20 Annual Membership - payable in cash
I understand that the activities of the Shed carry hazards and I will be doing them at my own risk. I understand that my safety is my own responsibility and confirm that I will comply with the Shed’s Health and Safety policy.
Please provide a signature to signify that you have read and agree to abide by the Hertford Mens Shed policies outlined above.
Should be Empty:

Hertford Men's Shed Membership Request Form