Membership Form

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ILEAP Membership and Support Form

Purpose

This form helps ILEAP get to know each member as an individual and understand how we can support them to take part safely, successfully and enjoyably.

The form is not designed to exclude participation. Information shared by families is considered alongside staff experience, common sense and session observations so that we can agree the right support approach together.

Please complete the form as fully as you can. If you are unsure about anything, or would prefer to talk things through, please contact us — we are happy to help.

Member photo
Uploading a clear photo can help staff recognise and support members more easily during sessions. (Max file size: 2MB)

Email *

Password*

Retype Password *

Membership and Contact Details

Member First Name *

Last Name *

Preferred Name/Nickname

Date of Birth (dd/mm/yyyy) *

Parent/carer completing form *

Relationship to Member *

Parent/Carer Mobile number *

Member's Address *

Please provide the address where the member currently lives.

School/college/workplace/day-service

Collection and leaving arrangements

Who normally drops off and collects the member? *

Is there anyone who should not collect the member?

If yes please give details

Can the member leave independently at the end of a session? *

Yes

Only with prior agreement

Please note: Parents/carers are responsible for ensuring members are collected on time. ILEAP staff may not always be able to remain after sessions due to other commitments. Where additional supervision is required outside agreed session times, additional charges will apply.

If the member is expected at a session but has not arrived, what would you normally expect ILEAP staff to do? *

No action needed — we will contact ILEAP if plans change

Please attempt to contact parent/carer

Emergency Contacts

Primary emergency contact *

Relationship to Member *

Emergency Phone *

Secondary emergency contact

Relationship to Member

Phone number

About the member - strengths first

Please tell us about the member as a person. What do they enjoy, what motivates them, what are they good at, and what helps them feel comfortable, confident and happy?

Favourite activities, interests, places, routines, themes or rewards

Is there anything staff should know that helps build a good connection and support the member well from the start?

Communication and understanding

How does the member usually communicate? *

Please tick all that apply

Speech

Signs / Makaton

Visual prompts

Communication device

Gestures

Other

Please give details

Are there any communication or understanding needs staff should be aware of?

Please tick all that apply

Hearing loss

Sight loss

May need support to understand verbal instructions

May say “yes” without fully understanding

May become anxious if plans change

What helps staff communicate and support the member well?

For example: simple language, extra processing time, visual support, reassurance or clear choices.

Health, Medication and Wellbeing

Are there any health or wellbeing needs staff should be aware of to help support the member safely? *

Please tick all that apply

Epilepsy

Allergies

Diabetes

Mental health / emotional regulation needs

Sensory needs

Other medical condition

None

Additional information staff should know

Diagnosis, disability or condition (optional)

If there is a diagnosis, disability or condition you would like ILEAP staff to be aware of, please tell us below.

Medication arrangements. *

Note: ILEAP staff cannot administer medication. Staff may only support members to take medication they are able to manage and administer themselves.
If a member is unable to manage medication safely with support, additional arrangements may be required for participation.
Please tick all that apply

No medication relevant to sessions

Carries own medication

Can self-administer with prompts

Medication may be needed during sessions

Emergency medication plan in place

Additional medication information

Eating, drinking and dietary information

Please include any allergies, dietary needs, swallowing concerns or eating/drinking information staff should be aware of.

Supporting documents

If there are any care plans, medical plans or guidance documents that would help staff support the member safely, you can upload them here.

For example:

Epilepsy care plans
Emergency medication plans
Allergy plans
Eating/drinking or swallowing guidance

Personal Care, Independence and Mobility

ILEAP supports independence wherever possible. ILEAP staff are unable to provide personal care, moving and handling or lifting. Staff may support and prompt members where appropriate, but cannot carry out personal care tasks for them.

Where additional support is needed, we will work with families to agree safe and appropriate arrangements wherever possible.

Toileting and personal care *

Please tick all that apply

Uses toilet independently

Needs reminders

Needs supervision nearby

Uses pads / nappies / equipment

Uses specific words, signs or communication for toileting

Mobility and physical support *

Please tick all that apply

Walks independently

Uses wheelchair

May need support with steps or stairs

Uses specialist equipment

May need additional arrangements for physical support

Additional information that may help staff support the member safely and comfortably

For example: continence, mobility, fatigue, physical support needs or anything important staff should be aware of.

Is there anything that may affect the member’s experience in a group setting, and what usually helps? *

For example: noise levels, waiting, transitions, personal space, routines or social situations.

Safety, Regulation and Support Needs

Are there any situations the member may find difficult, distressing or overwhelming?

For example: noise, crowds, waiting, changes of plan, transitions, road safety, water, money, social situations or online safety.

Are there any support needs, behaviours, vulnerabilities or safety considerations staff should be aware of?

Please tick all that apply

May run or hide when overwhelmed

Limited awareness of danger

May need close support in public places

Can become overwhelmed or anxious

May need extra preparation for transitions

Other

If you selected Other, please provide brief details

What usually helps the member feel safe, calm and well supported?

ILEAP staff are not trained to use restrictive physical interventions. Where behaviours place the member or others at significant risk, additional support arrangements will be required for participation.

Participation, Preferences and Inclusion

Which activities, interests or experiences does the member especially enjoy? *

Are there any activities or environments that may need adjustments or additional support?

For example: noise levels, busy places, waiting, group size, physical access or transitions.

Are there any new activities, experiences or places the member would particularly like to try or visit?

Photography and Media Consent *

Do you consent to ILEAP taking photographs or video footage of the member during activities and events, and using these images in our promotional materials, website and social media?

Media consent given

*** DO NOT PHOTOGRAPH ***

Decision-Making, Independence and Safety

Are there any areas where the member may need additional support, guidance or oversight to help keep them safe and well supported? *

Please tick all that apply

No additional concerns

Independent travel

Money handling

Relationships / personal safety

Social media / online safety

General decision-making

Other

Is there anything else staff should know to help support the member safely and respectfully?

If you selected Other, please provide details

Parent / Carer Declaration

Please read and confirm the statements below. *

I confirm the information provided is accurate and up to date to the best of my knowledge

I will let ILEAP know if important health, behaviour, medication or contact details change

I understand that ILEAP provides supported leisure activities

I understand that additional support arrangements may sometimes be needed to help participation remain safe and successful

Terms of Membership *

I accept the Membership Terms and Conditions

Payment Information

Coupon

Price for membership until 31 August

Discount Amount

Total Amount

Payment Method *

Credit or Debit Card

PayPal

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