Bletchley and Fenny Stratford Council Residents Free Swimming Application

Surname Forename

Address Postcode

Telephone number

Email address

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The membership that I am applying for is:

60years + 3-16 years Further Education 16-19 years Other

I would describe my ethnic origin as:

White (British) White other (please specify) Black Caribbean Black African Black Other (please specify) Bangladeshi Chinese Indian Pakistani

Other (please specify)

Date of Birth (mandatory) / /

Signature:

(under 16’s must have this form signed by a parent or guardian)

This free swimming initiative is being funded by and Fenny Stratford Town Council and will be reviewed every 6 months by the Full Council Please provide proof of eligibility with your application as specified overleaf

For Office Use:

Evidence Seen: 60+ yrs 3-16 yrs Further Ed 16-19yrs Other

Signed: Date: InspireAll manages these facilities in partnership with Council. InspireAll is a registered charity. Charity Number 1093653

Bletchley and Fenny Stratford Town Council Free Swim Eligibility Information The Town Council have agreed to fund swimming for the following residents:

Anyone In Receipt of any of the following Evidence required Council Tax Reduction Bill or Letter required Universal Credit Notification Letter Personal Independence Payment Notification Letter Employment and Support Allowance Notification Letter Income Support Notification Letter Invalid Care Allowance Notification Letter Working Tax Credit Notification Letter Pension Credit Notification Letter Anyone in the following categories Evidence required Unemployed Notification Letter Over 60 years of age Evidence of date of Birth Youths aged between 3 and 16 years of age Evidence of date of Birth Young people in further education aged 16 to 19 yrs. Evidence of Further Education

All categories require proof of address and the following documents are accepted for this:

 Letter from school  NHS Card/Letter  Medical appointment Letter  Council Tax Statement/Bill  Utility Bill (within the last 3 months)  Bank Statement  Driving Licence For Child cards please note that the document must clearly state the Child’s name and address and not that of the parent.

 Proof of age  Birth Certificate  Driving Licence (photo card)  Passport  School letter Proof of Entitlement

 Council Tax Reduction award letter  Universal Credit award letter  Personal Independence Payments award letter  Employment and Support Allowance award letter  Income Support award letter  Invalid Care Allowance award letter  Working Tax Credit award letter  Pension Credit award letter  Job Seekers Allowance award letter or proof of being registered unemployed Further Education

 School/College Letter or card