Membership Form – The Green Shed

Personal Information

Name *

Known as:

Paid date

Email *

Date of birth: *

Mobile No:

Tel no:

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

I want to be considered for a role in Shed’s Development Group: *

Emergency Contacts

Emergency Contact Name: *

Emergency Contact Phone No: *

Relationship to Emergency Contact: *

Doctors Name: *

Doctors Tel No: *

Details:

Please state any medical details of which we should be aware in case of emergency (e.g. diabetes, epilepsy, medication)

Shed Membership Fee

An annual donation of £12 on joining and each year thereafter to help with the upkeep of the Shed.

***Each session you attend is currently free ***(subject to Shed finances)

Payment method: *

Bank Transfer
Cheque

Cheques should be made payable to:-
The Green Shed - Sherborne

Natwest Bank
Account number - 83399453
Sort Code - 60-03-29

Declarations and Disclaimers

Safety

I understand that the activities of the Shed carry hazards and I will be doing them at my own risk. I understand that my safety is my own responsibility and confirm that I will comply with the Shed’s Health and Safety policy. I will wear any personal protective equipment deemed necessary for any particular item of equipment and will comply with any and all safety instructions. I agree to ensure my full understanding of the instructions for use and safety on every piece of equipment I use and I will act responsibly to ensure my own safety and that of
others. I understand that The Green Shed - Sherborne excludes all liability to the full extent permitted by law and accept that neither The Green Shed - Sherborne nor any of its Management Committee shall be liable for any direct or indirect loss, damage or injury arising from or in connection with my participation in the Shed’s activities and I waive all and any claims in this respect.

I hereby consent that I have read, understood and agree to the above statement. *

Yes, I consent

Health

I understand that I must disclose details about my health that might affect me in carrying out
the activities in The Green Shed - Sherborne. I understand that The Green Shed - Sherborne is not responsible for giving medical assistance or organising carers or medical support beyond seeking help in an emergency or referring me to professional services if they deem me to be at risk.

ALL medical information will be treated as confidential and held securely.

I hereby consent that I have read, understood and agree to the above statement. *

Yes, I consent

Name: skills? are

Privacy

I consent to the collection and use of my personal information for the purposes of my membership with The Green Shed - Sherborne and I understand that from time to time photographs and videos may be taken within the Shed. I consent to their use by The Green Shed - Sherborne and UK Men’s Sheds Association in publications, newsletters and in the media to highlight the good work of Men’s Sheds. I understand that this consent can be withdrawn at any time in writing.

I hereby consent that I have read, understood and agree to the above statement. *

Yes, I consent

ALL medical information will be treated as confidential and held securely. Your personal information will never be distributed, sold or shared with third parties not stated above, except if required by law.

Membership Application Form

Personal Information

Emergency Contacts

Shed Membership Fee

Declarations and Disclaimers

Safety

Health

Privacy