Bromley Mencap - Supporting Disabled People

June Sunday Social Club

Booking Form - Sunday Social Club

£5 per session including popcorn and a drink (please pay online for each date you want to attend before completing booking form). You can attend one or more sessions.

Closing date: 29 May.

Please note that there will NOT be sufficient staff to provide individual support or personal care to participants.

If you will need the support of a carer during the event, please ensure that you are accompanied to the event.

Select sessions you wish to attend: Sunday 7 June

Select sessions you wish to attend: Sunday 14 June

Select sessions you wish to attend: Sunday 21 June

Select sessions you wish to attend: Sunday 28 June

Title

Your first name

Your surname

Your address

Your postcode

Telephone number

Carer's Name

Email address

In case of emergency, please give details (including dosage) of any medication you take

Do you have epilepsy?

If yes, please provide details. Please note that medical consent is required to take part.

Is there anything else you think we should know about you? (e.g. any phobias or behaviour that may challenge)

Do you have any allergies, food intolerances or dietary requirements?

If yes, please provide details.

Please let us know if you require individual support

Please provide a named contact and telephone number that we can use in the event of an emergency (this number must be contactable during the activity hours)

The carer who will support me at the activity is

I understand that photographs and filming taken of me whilst I use Bromley Mencap’s services will be used to promote the services to others, help with fundraising and to raise the profile of the charity. The photographs and films may be used in leaflets, newspapers, exhibition displays, the Bromley Mencap website, the internet, monitoring reports to funders and newsletters. I give my consent to photographs and films of myself to be used for the above purposes.