MEMBERSHIP APPLICATION FORM

NAME: ………………………………………………Occupation………………………

PARTNER: ......………………………………………..Occupation....……………………

ADDRESS: .....……………………………………………………..................................

PHONE: home ……………..…...… mobile ......................…… work …..............

Email ………………………………………………………………….. (This is how we will contact you.)
Do you check your email often? YES / NO

DRIVERS LICENCE NO. .…………………………Photo ID sighted by ………….....…........ Member

HOW DID YOU HEAR ABOUT US? ……………………………………………….............................................................................
CHILDREN: NAME & DATE OF BIRTH
1. ……....………………............... ..../…./..... 2. …....................………… ..../…./.....
3. ……....………………...........… ..../…./..... 4. …………...……......…... ..../…./.....
5. …….......................................… ..../…./..... 6. ………………............… ..../…./.....

I,…………………………………………………………………………………..…… , declare
that the information given above is correct and I understand that I may be liable for prosecution if the information is found to be false for misleading, either in part or in whole. I have received the Members Information Booklet, read it in full and I completely understand the Terms and Conditions of borrowing toys from the Northam Toy Library, and that the Northam Toy Library takes no responsibility of injuries/damages incurred whilst I have toys in my possession. I understand the Toy Library is a not for profit group run by members who volunteer their time.  As a Member I will do my best to:
✔ attend roster duty at least 1/year (circle preferred day) Sat 9 - 10.30am or Thur 9 - 10am
✔ contribute a few hours annually towards the upkeep of toys
✔ take great care of the toys and store them indoors & under cover
✔ do my best to fix toys if I break them or lose items
✔ clean toys prior to returning
✔ replace batteries if required
✔ contribute time or $ towards fundraising activities. Only 2/year (circle preference)
Avon Decent Breakfast 3/8/13 OR Toodyay Show Parking Assistance 12/10/13


I have paid $........................... by cash or $.............................. by direct deposit to Northam Toy Library at Bankwest BSB 306 028 ACCOUNT NUMBER 035 2124 – Ref – Your Surname

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SIGNATURE                                                        DATE                         Member Receiving Application

Voucher? ……………………………...................…. Received from …..................................................
Notes ........................................................................................................................................................
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Please email form to northamtoylibrary@gmail.com or deliver to Northam Toy Library at 87 Duke St Northam 6401.  OPEN Saturdays (9 to 10.30am) & 1st & 3rd Thursdays (9 to 10am)