The Parents Consortium - supporting disabled children and their families

Full and Associate membership of The Parents Consortium is open to any parent or guardian of a disabled child aged under nineteen years and living in the Dartford, Gravesham or Swanley area. All full members have the option to become voting or non-voting (Associate) members. A Full voting member has the right to receive services, the newsletter, ability to hire the premises for special functions at a reduced rate and full voting rights at General Meetings, as well as eligibility for election to Council of Management. An Associate non-voting member receives the services and newsletters as above but has no legal liability and is not entitled to a vote. An Associate Member may stand for election on to the Council of Management. To become a full or associate member of the Parents Consortium simply fill in the details below and we'll be in contact shortly.

I wish to become a:	Full Associate Member of The Dartford & Gravesham Consortium Ltd.

Name: (of parent or guardian)
Address: (including postcode)
Email Address:
Telephone Number:

Child/Young person's Name:
Child/Young person's Impairment:	(e.g. Autism, Cerebral Palsy)
Child/Young person's Date of Birth:

Child/Young person's Name:
Child/Young person's Impairment:	(e.g. Autism, Cerebral Palsy)
Child/Young person's Date of Birth:

Name of Sibling:
Siblings Date of Birth:
Name of Sibling:
Siblings Date of Birth:
Name of Sibling:
Siblings Date of Birth:


Would you prefer to receive the newsletter by e-mail?	Yes No
Would you prefer to receive the newsletter in another format? (If so, please specify format)	Yes No

Any other relevant information

Ethnic Origin: (Please tick as appropriate)	British Asian Other Asian Black British - Afro/Carib Black British - Other Black Other Chinese Mixed Race White British White Irish Not Known Not Provided

The information disclosed will be held on a database and will be used within The Parents Consortium only.
It will not be given to a third party.