Membership

• Do you have or have you had mental health issues?

• Do you live or access services in Medway, Swale, Maidstone, Dartford, Gravesham or Swanley?

• Are you aged 17 or over?

If you have answered yes to all of the above, why not become a member of MEGAN CIC
and come along to one of our friendly and confidential groups.

You can use the online membership form below to become a member today or download the membership form at the bottom of the page and return it to us when you’re ready

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First Name & Surname *

*Please include full name to speed up the membership process*

Address *

Postcode *

Contact Number *

Email

Date of Birth *

GP Surgery

Do you have a mental health diagnosis? If yes, please state

Where did you hear about MEGAN CIC?

Gender *

• Male
• Female
• Transgender
• Other Gender Variant

Do you consider yourself to have a disability?

• Yes
• No

Sexual Orientation

• Bisexual
• Gay Man
• Gay Women / Lesbian
• Questioning
• Heterosexual
• Other

Ethnicity *

• White – English/Scottish/Welsh/Northern Irish/UK
• White – Irish
• White – Gypsy Or Irish Traveller
• White – Any Other White Background
• Mixed Ethnic Background
• Asian/Asian UK – Indian
• Asian/Asian UK – Pakistani
• Asian/Asian UK – Bangladeshi
• Asian/Asian UK – Chinese
• Asian/Asian UK – Any Other Asian Background
• Black/African/Caribbean Black UK – African
• Black/African/Caribbean Black UK – Caribbean
• Black/African/Caribbean Black UK – Any Other Black/African/Caribbean Background
• Other Ethnic Group – Arab
• Other Ethnic Group – Any Other

Religion or Belief

• No Religion
• Christian
• Buddhist
• Hindu
• Jewish
• Muslim
• Sikh
• Other Religion

The staff and volunteers at MEGAN CIC may, on occasion, wish to take photographs and/or video footage of you at group events and activities organized by MEGAN CIC. The reasons include: To have a visual record of the event, to advertise and promote the services both locally and nationally, to show to our funders and/or use as a tool to seek funding, to update the MEGAN CIC website/social media on the internet and to promote health and wellbeing initiatives.

• Check to acknowledge you agree to the above

General Data Protection Regulations (GDPR) Statement: We keep a record of the following information: name, address, contact number, email address, date of birth, mental health diagnosis, GP, where you heard about MEGAN CIC, equality and diversity data and records relating to the support you receive from MEGAN CIC. The information is used for monitoring purposes, to enable the distribution of relevant information and in case of an emergency or safeguarding concern; we would provide any relevant information to paramedics, police, and/or general health professionals. Your information will be held by MEGAN CIC on our Client Management System for the duration of your membership. MEGAN CIC would never sell, give out or distribute any details you have provided other than that outlined previously. All information collected is stored in line with the General Data Protection Regulations. Confidentiality Statement: MEGAN CIC take confidentiality very seriously. Anything discussed or disclosed within the groups will be kept confidential within MEGAN CIC. Group Facilitators and Directors reserve the right to breach this confidentiality statement for the following reasons: If there is a risk of harm to yourself, others or local/national security Where a worker is summoned by a court to give evidence In an emergency i.e. if the medical services or police were needed If we have concerns for a child’s welfare we will raise this as a child protection issue or concerns for a vulnerable adult this will be raised as a safeguarding issue with the appropriate persons. Agreement By submitting this form, I confirm that I have read, understood and agree for MEGAN CIC to hold my details as listed under the GDPR Statement for the purposes outlined and the MEGAN CIC Confidentiality Statement. You have the right to opt out at any point by contacting us when we will then dispose of your information securely. *

• Check to acknowledge you agree to the above

Submit

For more information or for any help – Contact us HERE