Joining form for individuals

*(denotes required field)

First Name: *

Last Name: *

Date of Birth *

Gender: *

Male

Female

E-mail address *

Telephone Number *

Address *

Name and telephone number of emergency contact *

Please inform us of any mobility, physical or mental health issues that you have. All information provided is strictly confidential.

Why do you want to join the timebank? (Tick all that apply) *

Do something in your community


Learn something new


Get practical help


Meet people


Other

Please enter the skills, help and/or benefits (such as performance tickets or gym activities) that you would like to RECEIVE through the Time Bank.

Please enter skills, help and/or benefits that you would like to OFFER as part of the timebank. It could be things that you do for yourself all the time that are really valuable to someone else.

Please provide the name, address and MOST IMPORTANTLY DAYTIME telephone numbers of two people you know (such as a friend or colleague, but not family member). This is to ensure that everyone involved in the Time Bank is safe. *

The Timebank will maintain a photographic record of the activities undertaken by participants.

These may be used in our newsletter and for general publicity, including the Haringey Timebank and Time Bank UK websites unless box is checked.

I agree to abide by the Haringey Timebank Code of Conduct and Terms of Use *

Code of Conduct and Terms of Use

How did you hear about the Haringey Timebank? (tick all that apply) *

Web search


Event


From a friend


Referred by an organisation or business


Leaflet


Other

Any other comments or questions

Anti-spam: Re-type the characters *