Membership

Grandparent membership form

If your grandchild has hemiplegia, then join HemiHelp. You will not only receive our regular newsletters and other benefits, but you will be part of a growing organisation that is dedicated to helping you.

Are you the parent of a child with hemiplegia? Fill in our Parent membership form.

Your details

Title:

First name: *

Surname: *

Address: *

Postcode: *

Tel:

Mobile:

Email address:

Receiving emails:

Please tick this box if you do NOT wish us to send you HemiHelp updates and event news by email.

Family information

Grandchild's first name:

Grandchild's last name:

Date of birth

Male or female:

Male

Female

Are you the primary carer for your grandchild?:

Yes

No

Education

Does your grandchild attend school?:

Yes

No

Not of school age

If yes, is it a state school, independent school or boarding school?:

State school

Independent school

Boarding school

If your grandchild attends school is it a mainstream school, a mainstream school with special unit or a special school?:

Mainstream

Mainstream with special unit

Special

PLEASE ENROL ME AS A MEMBER OF HEMIHELP

Membership donation: *

I will pay online by credit or debit card

I will pay by post

I will contact the office about membership donation

Please tell us how you will pay your membership donation.

Declaration: *

By becoming a member of HemiHelp I understand and accept that this CONFIDENTIAL information will be held on a computer under the rules of the Data Protection Act and will be for the exclusive use of HemiHelp, who undertake not to disclose this information to any other organisations without prior written consent.

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