Entry, Concession + Leisure Card Membership. Application Form
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1 Entry, Concession + Leisure Card Membership Application Form
2 ENTRY CARD + CONCESSION CARD + LEISURE CARD Our Entry Card offers you the opportunity to collect points by just taking part in activities such as the gym, swimming, classes, indoor and outdoor sports. You can redeem these points to earn FREE visits to enjoy more of your favourite activities. The more active you are the more FREE activities you can enjoy. See a member of staff about how to collect points. Our Concession Card is available if you meet the criteria detailed overleaf. Our Leisure Card gives you discounts and booking privileges on everyday activites as listed below. If you visit the centre more than twice a week and enjoy the gym, classes and swimming then you could save yourself some money with our Fitness Membership. Speak to the reception team for further details. Centre Privileges Free entry to Bletchley Leisure Centre, Oakgrove Leisure Centre and other Hertsmere Leisure operated sites Collect loyalty points to redeem within the centres to get FREE activities Booking privileges - activities/facilities can be booked up to 7 days in advance by phone or online Entry Card Concession Card Leisure Card Fitness Member Discounted centre activities FREE racket hire CATEGORIES: Junior: 0-15 years Adult: 16 + Family*: 2 adults or a single parent and up to 4 children Entry: Anyone can apply for a Entry card, free to all customers Concession: If you meet one or more of our criteria, hold a Passport to Leisure Card or aged 65 + you can apply for a concession membership Leisure: Anyone can apply, entitling you to discounted prices on selected actvities Leisure Card Prices (valid for 12 months) New / Renewal Leisure Card Adult (16 + ) Leisure Card Family* (2 adults, 2 children) Leisure Card Junior (0-15 years) Concession Card* Entry Card FREE FREE * Terms and conditions apply. Please speak to a member of staff. * Families must reside at the same address. Children must be under 16 on the date of purchase. Each family member will be issued their own card. ** See back page for concession eligibility. Please note: A 4 administration fee will be applied to lost cards.
3 APPLICANT DETAILS Please complete the form in BLOCK CAPITALS. Please tick which category applies to your application: JUNIOR ADULT FAMILY DISABILITY BENEFIT OTHER Please tick which card type applies to your application: ENTRY CARD CONCESSION CARD LEISURE CARD Applicant 1 Applicant 2 Applicant 3 Applicant 4
4 YOUR ADDRESS + CONTACT DETAILS Please complete the form in BLOCK CAPITALS. House no. / name: Address: Postcode: Tel (daytime): Tel (eve): Hertsmere Leisure are committed to protecting your privacy and sending you relevant information and offers. We do not share the information you give us with any other party. Please tick this box if you would prefer NOT to receive any information or offers. I am happy to be contacted by Hertsmere Leisure by and newsletters. Hertsmere Leisure is committed to ensuring equality of opportunity for all members of our community. Our policy is to ensure that no member of the public receives less favourable treatment on the grounds of race, colour, nationality or ethnicity. To help assess our effectiveness we have introduced a system of monitoring our customer base and would appreciate you ticking the appropriate box below. 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 I d rather not say Signature: Date: Prices are correct at time of print and subject to change without prior notice. Please visit for up-to-date information.
5 CONCESSION ELIGIBILITY If one of the below applies than you are eligible for a Concession Card. Simply complete the application form and hand it in to one of the centres listed on the back page along with proof of eligibility as detailed below. Please also include proof of your address (e.g. bank statement or utility bill dated within the last 3 months). If you receive... Council tax benefit Universal Credit Personal Independence Payment Employment and Support Allowance Income Support Invalid Care allowance Working Tax Credit Pension Credit Please bring... Current council tax bill or notification letter or allowance book or allowance book If you are... Please bring... Registered with the Employment Service In attendance at a youth/ adult training scheme A full time student in possession of an NUS/ OU Membership card Aged 65 or over An asylum seeker- under 18 years of age registered with Milton Keynes Council A foster carer A dependant A member of the armed forces Current NUS/OU membership card Birth certificate, driving licence or pension book Home Office status document MKC proof of address letter Foster carer ID card A dependant of a Silver Card holder ID card
6 TERMS AND CONDITIONS OF USE The Concession Card is only available if you meet the set criteria. Hertsmere Leisure reserves the right, at its discretion, to withdraw a Entry/Concession/Leisure Card and the benefits to any person who does not conform with any of these conditions or for improper use of the card. An Entry/Concession/Leisure Card must be shown at reception when using the facilities, otherwise normal charges will apply. Use of the Entry/Concession/Leisure Card is restricted to one normal session. However, if there are any other spaces available at the end of the session it may be re-booked. (Applies during off-peak hours only). An Entry/Concession/Leisure Card cannot be used in conjunction with any other offers or discount saver schemes. Entry/Concession/Leisure Card members are subject to the general establishment rules for all leisure centres operated by Hertsmere Leisure. Entry/Concession/Leisure Cards are not transferable or refundable. OFFICE USE ONLY Proof of address: Note document seen (Residents only) Proof of eligibility: Note document seen (Concessions only) Card no. issued Receptionist initials: Cash / Credit card: Expiry date: Analysis code: Receipt no.: Princes Way, Bletchley, Milton Keynes, Bucks, MK2 2HQ Tel: Brickhill Street, Middleton, Milton Keynes, Bucks, MK10 9JQ Tel: Holborn Crescent, Tattenhoe, Milton Keynes, Bucks, MK4 3EQ Tel: Hertsmere Leisure manages these faciltiies in partnership with Milton Keynes Council Hertsmere Leisure is a Registered Charity. Charity No ISSUE 02. APRIL 2018
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