fbpx

T: 01438 729461
M: 07748 690989
E: This email address is being protected from spambots. You need JavaScript enabled to view it.
Office hours: 9.00am to 3.00pm

Member Registration

 

Are you a Hertfordshire resident?


Unfortunately we are unable to accept your registration at this time, as Phoenix only receive funding for residents living within the County of Hertfordshire.

To create an account please enter a username, email and password below...

Username:
Email:
Password:

Parents / Carers


Parent 1 Full Name:
Parent 2 Full Name:
Address:
Postcode:
Mobile/SMS:
Add to WhatsApp group?
PLEASE ADD my phone number to the WhatsApp group (where we advertise activities).

DO NOT ADD my phone number to the WhatsApp group.

Do you have a hearing loss?
First Language:
Do you consider yourself to have a disability?

Are there any adaptions that we can make to ensure that Phoenix is accessible to you?:

Children


How many children:

Photo Consent


We require parental consent before we use photos that others will view. For example, our annual yearbook, on our website and social media and funders may also like to see them for evidence.

I DO GIVE permission for my child/ren to be photographed and images used for publicity purposes by The Phoenix Group or by our funders. Photos that contain images of your child may also be displayed on our Facebook page.

I DO NOT GIVE give permission for my child/ren to be photographed for publicity or any other purposes by The Phoenix Group for Deaf Children

Transport Consent


We may need to provide transport for an activity for your child. In these circumstance, we would need parental consent if they are under the age of 16 years. Please tick yes/no to consent to transport.

YES I do give transport consent.

NO I do not give transport consent.

Emergency Contact Details


Name of Person 1:
Relationship to child:
Mobile Number:
Method of Contact:
Name of Person 2:
Relationship to child:
Mobile Number: Method of Contact:
Other information that would be helpful for us to know about your child:
Are you on low income and in receipt of Universal Credit (Not PIP or DLA)?

If Yes, please provide details:

This information helps us to understand which families may be entitled to some subsidised activities and food vouchers from Hertfordshire County Council.

Below is information that we need to collect as required by our funders. Please use one tick for each member of your family. Please complete all sections.

Ethnic background of parents/carer and children (each tick = a family member)

White
English/Scottish/Welsh/Irish/Northern Irish
Gypsy or Irish Traveller
Any other white background

Asian
Mixed ethnic background
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background

Black/African/Caribbean/Black UK
English/Scottish/Welsh/Irish/Northern Irish
African
Caribbean
Any other Black/African/Caribbean background

Other ethnic Group
Arab
Any other
Parents or Carers age group (each tick = a family member)

0 - 24 years
25 - 64 years
65+ years

Religion or belief (each tick = a family member)

No religion
Christian
Buddhist
Hindu
Jewish
Muslim
Sikh
Other religion
Prefer not to say
I agree to the terms & conditions