Be Buckfastleigh Membership Form
By filling out this form you will be applying for a Be Buckfastleigh Membership.
Sign in to Google to save your progress. Learn more
The Information you provide here will be used for monitoring and evaluation purposes. We may share aggregated data with our funders, research partners and trusted third parties to evaluate our projects and participation, and to develop new services. When you join Be Buckfastleigh, you are agreeing to be added to our mailing list – which we will use to update you with opportunities and events at Be Buckfastleigh, and to let you know of anything important relating to your membership
Please fill out a form for each member of your household.
Personal Information
First Name *
Last Name *
Postcode *
Telephone number *
Do you consent to Be Buckfastleigh using any photos or videos that they have of you? *
Which Be Buckfastleigh activities are you interested in? *
Are you on income related benefits? *
Do you have any disabilities? *
Do you have any health issues? *
Do you have any barriers that might stop you from taking part in activities (such as health issues, lack of funds, etc)? *
If you answered 'yes' to having barriers, what are these barriers?
ALL THE QUESTIONS BELOW APPLY ONLY FOR CHILDREN'S MEMBERSHIP APPLICATIONS! If you are an adult applying for a membership, please choose N/A for each required answer, or skip the following quesions. Thank you!
What school or education setting do you go to? *
If you answered 'other' above, please tell us where below
Emergency Contact Details
Do you give consent for Emergency First Aid?
Do you receive benefit related free school meals? *
Do you have any special education needs? *
Do you have any disabilities? *
Are you a child in the care system (living with foster parents, in a residential children's home, etc) *
Are you a young carer (a young carer is someone aged 25 and under who cares for a friend or family member who, due to illness, disability, a mental health problem, or an addiction, can not cope without their support)? *
Do you have an Early Help Plan? *
Do you have a Child Protection Plan? *
Do you have an EHC Plan? *
Do you have low attendance at school, or are at risk of being excluded? *
Are you living in a high area of deprivation, or your family is on a low income? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy