The Jack Ward Inclusion Initiative Membership Form

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Please complete this form if you wish to become a member of the Jack Ward Inclusion Initiative. We are a group focusing on supporting adults and children with additional vulnerabilities, from additional needs, to the LGBT+ community, to those living in poverty, or those who just need a support network. If you need help in any way, we will have your back. Please complete this form to register interest for membership and someone with contact you within five working days.

Email *

Which of these categories applies to you or a member of your household? *

Additional vulnerabilities, including physical and mental health illnesses and disabilities

LGBT+

Domestic violence survivor

Receiving benefits (working age/disability/child-related/pension-related benefits included)

Other:

Required

Name of person completing this form *

Date of Birth (if person completing form is under 18)

YYYY

Name of parent or guardian (if person completing form is under 18)

Telephone Number *

A copy of your responses will be emailed to the address you provided.

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