Membership Signup - Washbrooks Family Farm

Customer to complete Section 1 for each individual member

Membership can only be issued in person to those present, or on behalf of those present.

Any person 15 years and under must have a person aged 16 years or over complete this form on their behalf.

Please complete carefully and accurately.

For Washbrooks Staff

Take photo of the member, this is required for membership and we will need this later.
Note: GDPR clear and centralised head/shoulder shot ensuring no-one in background.

Section 1 – FOR CUSTOMER

Are you signing up on behalf of somebody else? *

Membership can only be issued in person to those present, or on behalf of those present.
Any person 15 years and under must have a person aged 16 years or over complete Section 1 on their behalf.

Member's Name *

First

Last

Member's Date of Birth (DD/MM/YYYY) *

If the Member is entitled to DLA (Disability Living Allowance) has the letter dated within the last 2 years been seen? *

Yes
Not Applicable (N/A)

Note: If the DLA letter has not been seen – unable to proceed. Please bring the letter on your next visit.

Email *

Note: Email of member or person signing up on behalf of member 15 years and under. Please check email inputted correctly.

Phone *

In case of a lost card or emergency.

Terms & Conditions

You can read the Terms & Conditions by clicking here and/or review copy by asking a member of staff.

By taking out membership you accept these terms and conditions of use *

I agree

Signature *

Section 2 – FOR WASHBROOKS USE

Please select photo from library.

Photo *

Click or drag a file to this area to upload.

Note: Ensure photo is uploaded. ALL membership forms must contain a photo of the member.

Unique Membership Number *

Note: Carefully input number from membership card here.

Membership Type *

Season
DLA/PIP (Disability Living Allowance/Personal Independence Payment)
Life
Other

Note: Write membership type on card to validate

Payment Methods *

Card
Cash
Voucher
Other

Please confirm how payment will be made.
Note: More than one box can be ticked.

Staff Name *

Please add your name

Final Washbrook's check's

Once the submit button is pressed the membership process is complete upon which the customer details will enter our system.

Upon submission a copy of the customer’s application is emailed to the email provided.