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About
Membership
Events
Gallery
Contact

New Membership Form

1st Parent/Carer Full Name: *

1st Email address: *

2nd Parent/Carer Full Name:

2nd Email address:

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone No: 1st *

Telephone No: 2nd

Mobile No(s): 1st

Mobile No(s): 2nd

1st Child Full Name: *

Sex: *

MALE
FEMALE

Physical Disabilities / Additional needs? *

Deaf: *

Date of Birth: *

School Attended:

2nd Child Full Name:

Sex:

MALE
FEMALE

Physical Disabilities / Additional needs?

Deaf:

Date of Birth:

School Attended:

3rd Child Full Name:

Sex:

MALE
FEMALE

Physical Disabilities / Additional needs?

Deaf:

Date of Birth:

School Attended:

4th Child Full Name:

Sex:

MALE
FEMALE

Physical Disabilities / Additional needs?

Deaf:

Date of Birth:

School Attended:

Additional Children: Please supply same information as per above.

Deaf Child Preferred Communication Method:

BSL
Total Communication
Oral

Other preferred communication (please state):

Ethnicity of Family:

Choice 1

I/we agree to the information on this form being kept on a secure database for the use of the society, in its operations, and I understand that KDCS will not pass my details on to any third parties.

Choice 1

I/We give permission for photographs/videos to be taken of my child(ren) at KDCS events for the charity's fundraising and promotional purposes.

What would you like to see KDCS offer its members?

Where did you hear about us?

NHS referral
School
Internet search
Facebook
Twitter
Email
Friend/Family

Other (please state)

KDCS Private Facebook Group

KDCS has a private online facebook group called ‘KDCS Private Members Group'. So that we can add you to the group please can you provide your facebook profile name/s above if different from the name provided. The link to the group will be available following form submission. We also welcome our deaf members over the age of 13 to also join our private facebook group if they would like token up to date with our news.

Date: *

Captcha *

If you experience any problems then please contact us here.

KDCS

E: office@kdcs.org | T: 07557 334 347
The Maidstone Studios, New Cut Road, Vinters Park, ME14 5NZ