Become a Member

Please fill in the online form below or, if you prefer, download a paper version here (the postal address is on the form and available from our contact page on this site).

The information you provide will be treated in the strictest confidence.

Membership Application Form

I/We consent to this information being held on the WPCC database:

Yes

No

I am a Parent Carer:

Yes

No

I am a representative of a support group:

Yes

No

I am a practitioner/professional:

Yes

No

(Please include Spouse or Partner if you are a parent or carer and they will be participating in family events)

How do you prefer to be contacted:

I am happy to receive information by email.
I prefer paper copy posted to my address.

Only parent carer members need to complete the rest of this form.

Child One

Child Two

Child Three

Child Four

Which of your children has a disability or additional needs?

What is your child’s condition?

Does your child use a wheelchair?

Yes

No

Thank you for completing this form, please submit your information now:

Data Protection
We are committed to keeping customer information confidential and it is used solely for the purpose of serving you better.
We will only use the information that we collect about you lawfully (in accordance with the Data Protection Act 1998).
In order for us to provide the best possible level of service, we need to gather certain information about you and your child. The information you provide will be kept confidential and used to support your relationship with WPCC.
We do not share our information with any other organisations for marketing purposes.

Website Tracking
We track the way our website is used. The information we gather is analysed only in the aggregate. This means that we look at website use statistics as a sum total and not at individual level. The statistics we monitor will include no personally identifying information.