Membership Form

            

 

 

 

Dudley Deaf Children's Society

 

As a member you and your family will be sent an invitation and a very warm welcome to all our events throughout the year.

 

Registration is easy. Please complete this form and return it to:

 

• Your Resource Base or Listen and Learn Centre, your Visiting Teacher of the Deaf, or post it to: The Membership Secretary, Mrs. Debbie Gough, 258 Wolverhampton Road, Sedgley, Dudley DY3 1RD
  

 

Name of Hearing Impaired Child

 

First Name    ……………………………. Last name…………………………………..

 

Age of child……………………….. Number of other children in the family………...

 

Parent / Carer details

 

Title: Mr / Mrs / Ms …………. Name……………………………………………….

 

Your address …………………………………………………………………………….

 

Post code………………………….. Phone number………………………….............

 

** If you would prefer to receive your information by email only **

 

email………………………………………………………………………………………

 

Your child's school………………………………………………………………………..

 

Please pass my details onto the National Deaf Children's Society

(Please tick)

I do not wish my details to be passed onto the National Deaf Children's Society

(Please cross)

 

If you would like a copy of this newsletter in an alternative language, please indicate which

 

language you would prefer e.g. Urdu, ……………….

 

We would like your permission to use appropriate photographic images of your child in

 

our newsletter or on the DDCS website. Please indicate yes

o or no
o