13415 broxtowe app fri

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Broxtowe Leisure Cardand MembershipApplication Form



Leisure Card and Membership Terms and Conditions

CancellationsNon-attendance of any activity or session bookingor cancellation on the day will be chargeable.We reserve the right to charge the full rate forany booking that is not cancelled or not attended.This applies to all categories of membership

including Vitality Health and Fitness.

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Broxtowe Leisure Card and Membership Application Form

General

1: The Broxtowe Leisure Card is at all times theproperty of Broxtowe Borough Council and must besurrendered to the council on demand.

2: The Broxtowe Leisure Card is annually renewable. Itis valid from the date of issue and eligibility criteriamust be re-validated at renewal.

3: The Broxtowe Leisure Card is not transferable andmust be used only by the person for whom it was issued.

4: All changes to personal details must be disclosed toBroxtowe Borough Council at the earliest opportunity.

5: Broxtowe Borough Council reserves the right to refuseto issue or renew Leisure Cards and refuse admission tofacilities and to alter or withdraw the Leisure Cardmembership at any time without refund.

6: Broxtowe Leisure Card customers must presenttheir Leisure Card at reception on every visit. TheBroxtowe Leisure Card must be available for inspectionat any time. If it cannot be produced or is in any waynot valid the full price for the activity must be paidwithout right of refund.

7: All Leisure Card holders must allow an electronicphotograph of the applicant to be taken and held onthe Council’s membership system. The Leisure Cardphotograph must at all times be a true likeness of theholder. In the event of a change in the appearance ofthe cardholder, the Council reserves the right torequest a new photograph to be taken.

8: Any breach of these conditions will render theLeisure Cardholder liable to forfeiture.

9: Concessions may not apply in the followingcircumstances:l Group bookings or room hirel When a person entitled to the concessionary rate

shares an activity with a non-eligible person a courtsupplement fee may apply (i.e. squash, badminton)

l Coursesl Sports Pitchesl

Other items as specified in published price listsl Adhoc activities/events that may not take place atall sites

10: Student applicants may be required to provideproof of full-time status. We have the right to refuse aconcessionary membership where we suspect studentsare not in full time education.

11: Standard session times must be adhered to and maybe limited to one session during peak times.

12: Broxtowe Leisure Card customers wishing to usethe fitness suites and health and fitness classes must be16 years of age or over (14yrs and 15yrs olds are able touse the fitness suite but must be accompanied by an

inducted adult). Specialist programmed sessionsappropriate for 11 to 15 year olds are subject to availability.

13: Broxtowe Leisure Card customers must abide byall programming arrangements. Use of facilities is

subject to opening hours, programming, availabilityand booking requirements.

14: Facilities may be withdrawn or restricted from timeto time to perform essential repairs and refurbishment.Where possible two weeks notice will be given.Other sites in the Borough may provide the same orsimilar facilities.

15: Broxtowe Borough Council reserves the right toamend or cancel the programme of sessions andactivities available at Leisure and Culture sites.

16: Prices will be subject to periodic review.

17: The Broxtowe Leisure Card scheme cannot be usedin conjunction with any other special offer.

18: Broxtowe Borough Council reserves the right toamend terms, conditions and policies.

19: Lost, Stolen and Damaged CardsA charge will be made for replacement cards, unlessbeing replaced through normal wear and tear, thena replacement card will be issued free of charge.

20: RefundsNo refunds for Broxtowe Leisure Cards will be given.No refunds will be given for the unavailability of anyactivity/facility/class/equipment or limited sessions atbusy or holiday periods (including public holidays).

21: Vitality Health and Fitness Membership Cancellation

The monthly Vitality Health and Fitness Membershipis subject to 30 days notice of cancellation.

22: Direct Debit CollectionsFor membership taken out from the 1st to the 15th ofthe month payments will be collected on the 5th, formemberships taken out between the 16th and end ofthe month payments will be collected on the 20th.

Liability and Lockers (Leisure Facilities)All belongings should be kept in lockers sincefacilities for storing personal belongings in thefitness suites are limited and unsecured.Broxtowe Borough Council accepts no responsibilitywhatsoever for customer’s property.



3Broxtowe Leisure Card and Membership Application Form

What is a Leisure Card ? The Leisure Card entitles the customer to receive special benefits within the fourLeisure Centres, D. H. Lawrence Heritage Centre and Birthplace Museum all providedby Broxtowe Borough Council.

Who can have a Leisure Card ?Everyone is welcome to apply for a Leisure Card regardless of where they live and somepeople may be eligible for a concessionary Leisure Card. Apply for yours today!

Where can I use my Leisure Card ?You can use your Leisure Card at the following Broxtowe Borough Council facilities:l Bramcote Leisure Centrel Chilwell Olympia Sports Centrel D. H. Lawrence Birthplace Museuml

D. H. Lawrence Heritage Centrel Eastwood Community Sports Centrel Kimberley Leisure Centre

Take a look at the benefits available to youl Discounted rates (up to 60%) on many activitiesl Priority book ahead period for facilities and activitiesl Online booking and cancellationl No need to pay at time of booking - simply pay when you arrive for your activityl Opportunity to receive advanced notice of new activities, promotions and events

How Do I Apply For My Leisure Card ?Simply fill in the application form at the end ofthis leaflet and hand it in to any Broxtowe BoroughLeisure and Culture site with proof of identity,age, concession and address as appropriate.Your Leisure Card will be processed and activatedimmediately and you can then start enjoying thebenefits of your Broxtowe Leisure Card.

What Proof of Identity/Concession Do I Need ?1) The Leisure CardProof of identity, age and address e.g.Passport,Driving Licence,Birth Certificate,Council Tax Bill and Utility Bill

2) The Concessionary Leisure CardYou may be eligible to receive further discounts depending upon your circumstances.

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Who qualifies for a Concessionary Leisure Card and what proof ofidentity do you need?Anyone applying for a concessionary Leisure Card will need to provide proof of identityincluding age and current address. Use the table below to see what are acceptableforms of proof of concession for different circumstances.

WHO IS ELIGIBLE? PROOF REQUIRED?

Full time students over 16 NUS Card or written verification from College/*Part time courses are not eligible University/School including official stampPeople who are aged 60 or over Birth Certificate, Passport, Medical Card, Bus PassPeople living with a disability or Written confirmation from Doctor or relevantlimiting long term illness Health Professional, Blue Badge Holder, War

Pensions Mobility Supplement, Registered Blindor people in receipt of one of the following:

Incapacity Benefit Letter from benefits agency

Disability Living Allowance Letter from benefits agencyIndustrial Injuries Benefit Letter from benefits agencySevere Disablement Allowance Letter from benefits agencyPeople in receipt of:

Income Support Letter from benefits agencyJob Seekers Allowance Letter from benefits agencyCarers Allowance Letter from benefits agency

The categories of concession below are only available to residents ofthe Borough of Broxtowe:

Looked After Children Written Confirmation/Letter from your Social Worker(0-15 years) confirming your status as a Looked After Child and

proof of residency within the Borough of Broxtowe.After Care Pathway Written Confirmation/Letter from your Social(16-24 years) Worker confirming your status on the After Care

Pathway and proof of residency within theBorough of Broxtowe.

Carer Of Child (Looked After Child) Written Confirmation/Letter from Local AuthorityThis concessionary category confirming status as Carer of Child (Looked Afteris only available when the Child) within the last 18 months and proof of

carer is accompanying the residency within the Borough of Broxtowe.looked after child.

3) Junior Leisure Card

WHO IS ELIGIBLE? PROOF REQUIRED?

Children and Young People Birth Certificate, Passport, Medical Card, written(0-15 years) verification from School including official stamp

Please remember to bring your proof of eligibility, as Leisure Cards cannot be issued

without it. All Leisure Cards are annually renewable with proof of eligibility required.

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(0-15 years)

(0-15 years)

Please complete this form in block capitals and take it into your chosen Leisure andCulture site on your next visit. (Postal applications cannot be accepted)

Carer’s Allowance

Full Time student (16+)



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I am a:n New Member n Returning Member

Do you have a valid Broxtowe Leisure Card? n No n Yes Number______________________

If no, please complete the Leisure Card application form on the reverse of this form.

I would like to apply for the following Membership:

n Vitality Monthly Single n Vitality Annual Single Concession

n Vitality Monthly Joint n Vitality Junior Annual

n Vitality Monthly Concession n Vitality SHOKK Annual

n Vitality Monthly Junior n Vitality Welcome Month

n Vitality SHOKK Junior n Vitality Concession Welcome Month

n Vitality Annual Single n Vitality Junior Welcome Month

n Vitality Annual Joint n Vitality SHOKK Welcome Month

n Vitality Corporate n D. H. Lawrence Heritage Adult

n D. H. Lawrence Heritage Concession n D. H. Lawrence Heritage Junior

Proof of Concessionary eligibility is required for Concessionary and Junior Membership types.

All Applicants for the Broxtowe Leisure Card/Membership must sign below.All information collected on this form will be stored in Broxtowe Borough Council andAquaterra Leisure membership databases. It will only be used for administration of the

membership and marketing of similar services. If you wish to receive advance notice ofBroxtowe Borough Council activities, promotions and events please tick heren

I have read, understand and agree to the terms and conditions of the Broxtowe Leisure Card andMembership Schemes. I confirm that the information I have supplied is accurate and should anyof my circumstances change I will inform Broxtowe Borough Council.

Signature Date / /

If the applicant is under 16 years old a parent or legal guardian/carer must sign this application form.

Office Use Only: n BLC n COSC n KLC n ECSC n DHLM n DHLDCustomer has previously had a membership? Yes n No n

n Identity Verified n Concessionary Category Verified

If Corporate membership, name of Company:

Joining Fee £ Membership Fee £

Leisure Card No. Comments

Staff Name Date / / DD Date / /

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Please complete the following form if you wish to join as a Vitality Health and Fitnessor D. H. Lawrence Heritage member

Application details:



Vitality Health and Fitness MembershipsAlong with all the benefits of a Broxtowe Leisure Card, Vitality Health and Fitness Members areentitled to unlimited use of the health and fitness facilities at three of Broxtowe Borough’sLeisure Centres, these include.

Facilities Bramcote Leisure Chilwell Olympia Kimberley LeisureCentre Sports Centre Centre

Fitness Suite

Swimming

Health & Fitness Classes

Health Suite

Shokk Youth Gym

Use of activities and facilities are subject to opening times, programming, availability andbooking requirements.

We offer a range of membership types depending on your needs and circumstances. To discussthe best membership option for you please contact one of the Leisure Centres where aMembership Advisor will be happy to help!

Vitality Health and Fitness Memberships have no hidden contract periods.

D. H. Lawrence MembershipsAn Annual Membership for D. H. Lawrence Heritage entitles members to unlimited generaladmission to both the D. H. Lawrence Heritage Centre and Birthplace Museum for a 12 monthperiod.* Benefits include:l Guided tours of the D. H. Lawrence Birthplace Museum, including themed seasonal toursl Unlimited access to exhibitions and preview events within the Rainbow Galleryl Unlimited access to the Durban House Exhibition on Lawrence and Mining historyl Free entry to children’s holiday craft sessionsl Seasonal discounts on gifts and memorabilia

D. H. Lawrence Annual Members automatically received all of the benefits enjoyed by BroxtoweLeisure cardholders.

* Additional charges may apply for special one-off events and activities.

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Bramcote Leisure Centre, Derby Road,

Bramcote, Nottingham. NG9 3GFTelephone: 0115 917 3000 Fax: 0115 917 3020

Email: [email protected]

Eastwood Community Sports Centre, Mansfield

Road, Eastwood, Nottingham. NG16 3EB

Telephone: 01773 770099Email: [email protected]

D. H. Lawrence Heritage, Mansfield Road,

Eastwood, Nottingham NG16 3DZ

Telephone: 01773 717353


Kimberley Leisure Centre, Newdigate Street,

Kimberley, Nottingham. NG16 2NJ

Telephone: 0115 917 3366 Fax: 0115 917 3367Email: [email protected]

Chilwell Olympia Sports Centre, Bye Pass Road,

Chilwell, Nottingham. NG9 5HRTelephone: 0115 917 3333 Fax: 0115 917 3334


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Contact us at:

Broxtowe Borough Council, Foster Avenue, Beeston, Nottingham, NG9 1ABTelephone: 0115 917 3418 Fax: 0115 917 3508

E-mail: [email protected]

Website: www.broxtowe.gov.uk

Large print format available upon request.

Please telephone 0115 917 3418 to request your copy.

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13415 broxtowe app fri

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