Charity

Welcome to the Steel Bones Family Registration Form. The enables you to register with us for a FREE family pack and attend our events in person or online. Please note the emergency contact details will be held in strictest confidence and only accessed when if you became unwell on one of our online or in person events but also necessary in case we were unable to reach you.

By signing up to receive a Steel Bones pack you are also agreeing to abide by our Steel Bones Code and policies. PLEASE READ THIS HERE:
Steel Bones Family Agreement: https://steelbones-my.sharepoint.com/:b:/g/personal/steelbones_steelbones_onmicrosoft_com/EQuLRuc5M69LnaConvi-YfIB1tVmsC6Cb10muiCBboFMGg?e=WrwyaA
Steel Bones Community Culture: https://steelbones-my.sharepoint.com/:b:/g/personal/steelbones_steelbones_onmicrosoft_com/EZo4ul-LrwZOpyKa7vkKxzQBMPw_ByQaXoU4jOE7i3qygQ?e=pA8FOl

* indicates required

Email Address *

First Name

Last Name

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

What is your favourite thing to do? Hobby/interest

Who is in your family? (Names and ages please)

Please state Amputee's Name and type of amputation

Whats the amputee's date of birth?

What date did the amputation take place?

What challenges are your family currently facing? *

What is going really well for your family?

What Prosthetic Centre do you attend?

Emergency Contact Details

Phone Number