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WIGWAM |
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SUPPORT |
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GROUP |
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Because we care |
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I am existing member (update of details) Or I am a new member *please delete as appropriate |
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Name ... .. |
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Address .. |
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.. |
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Post Code.. .. |
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Telephone Number .. |
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Mobile Number .. |
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Name of child with a special need .. |
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Their date of birth .. |
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Name/s of sibling/s .. |
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.. |
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.. |
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Would you prefer to receive letter/newsletters/diary dates etc by Post ...or email ... |
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If email please give email address . |
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I agree to Wigwam Support Group keeping the above mentioned details on file
I agree to Wigwam keeping photos of my child in their Social Keepsake Books .
Signed ...Date |