Membership Form

Family Full / Associate Membership

 

Name of deaf child: ……………………………………………..Date of birth………………..

 

Preferred method of communication: (speech/BSL/other)……………………………..

 

Name of Siblings: ………………………………………………..Date of birth………………..

 

………………………………………………….Date of birth…………………

 

………………………………………………….Date of birth…………………

 

Ethnic background……………………………………………………………………..

 

Parents Name: ………………………………………………….. Deaf/ Hearing

 

Parents preferred method of communication: (spoken English/BSL/other)

 

Email: …………………………………………………………………………………………………….

 

Phone / text: ……………………………………………………………………………………………

 

Address: ………………………………………………………………………………………………………………

 

………………………………………………………………………………………………………………

 

Live in Blackpool/ Fylde and Wyre/ other: ……………………………………………………

 

Name of Teacher of the Deaf supported by………………………………………….

 

Under which Audiology Dept/Cochlear Implant Team………………………………….

 

Our group is run by parents and volunteers. Can you help fundraise or with admin? Y / N. Do you have skills such as craft/face painting/cake making/ publicity/ applying for grants/ finance/making presentations/ training / childcare/ other? Y/ N

 

Where did you hear about Sign Hi Say Hi?………………………………………………………..

 

NDCS Member: Yes/No.                                     (We suggest all families join NDCS)

 

Date:……………….   Full or Associate membership (please circle)

N.B. Associate membership applies to those families residing outside SHSH area. Associate members will be entitled to discounted club rates but have no voting rights.

 

Membership runs September – August each year.

 

Please post forms and £5 membership per family to:

 

Membership Secretary:

 

Michelle Stewart

 

7 Blackpool Road

Carleton

Poulton-le-Fylde

Lancashire

FY6 7QB

 

Telephone number: 01253 891185

 

Email: m.l.stewart@hotmail.co.uk

 

SHSH has a Designated Child Protection Officer you can contact with any concerns.

Designated Child Protection Officer – Iain Phillips

Mobile:- 07814 243228

email:- bukweetz1@gmail.com