Leisure Card Enrolment Form - Wellington City Council
Leisure Card Enrolment Form - Wellington City Council
Leisure Card Enrolment Form - Wellington City Council
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PDWCC83818<br />
Fold in half, seal and return<br />
Freepost 2199<br />
Recreation <strong>Wellington</strong> (SECC07)<br />
<strong>Wellington</strong> <strong>City</strong> <strong>Council</strong><br />
PO Box 2199<br />
<strong>Wellington</strong> 6140<br />
<strong>Wellington</strong> <strong>City</strong> <strong>Council</strong>’s <strong>Leisure</strong> <strong>Card</strong> allows people on low incomes and people who<br />
meet other criteria discounted entry into a range of recreation and leisure services.<br />
You qualify for the card if you are a <strong>Wellington</strong> <strong>City</strong> resident and:<br />
• a Community Services <strong>Card</strong> holder or<br />
• on the Invalid’s or Sickness benefit or<br />
• a recent migrant (within last six months) or<br />
If you are not eligible please pass this on to someone who is.<br />
• on the Green Prescription (GRx) scheme or<br />
• a <strong>Wellington</strong> <strong>City</strong> <strong>Council</strong> city housing tenant or<br />
• a SuperGold <strong>Card</strong> holder.
What you need to include<br />
with your <strong>Leisure</strong> <strong>Card</strong><br />
enrolment form<br />
1. ONE of the following:<br />
OR<br />
a photocopy of both sides of your<br />
Community Services (CSC) or<br />
SuperGold card (SGC)<br />
Green prescription referral form<br />
OR a recent letter from WINZ, that shows your name, address and client number.<br />
2. Proof that you live in <strong>Wellington</strong><br />
Photocopy or tear the top off a bill showing your name<br />
and address.<br />
3. Photo<br />
1. Send a head and shoulders photo of yourself with<br />
your enrolment form.<br />
OR 2. You may email your photo to leisurecard@wcc.govt.nz<br />
Please put your name as the subject line.<br />
OR 3. You can get your photo taken for your <strong>Leisure</strong> <strong>Card</strong><br />
application at these <strong>Wellington</strong> <strong>City</strong> <strong>Council</strong> facilities:<br />
Kilbirnie Pool Reception 9–10.30am, Mon–Fri<br />
Kilbirnie Crescent<br />
Kilbirnie Recreation Centre 1–3pm, Mon–Fri<br />
Kilbirnie Crescent<br />
Freyberg Fitness Centre 10am–12noon, Mon–Fri<br />
(upstairs at Freyberg Pool)<br />
Karori Pool, Donald Street 10am–12noon, Mon–Fri<br />
Tawa Pool, Davies Street 10am–12noon, Mon–Fri<br />
<strong>Wellington</strong> <strong>City</strong> <strong>Council</strong> Reception 1–2pm, Fridays<br />
Wakefield Street<br />
Smart Newtown 10am–2pm, Mon–Fri<br />
(next to Newtown Library)<br />
Keith Spry Pool (Johnsonville) 10am–12noon, Mon–Fri<br />
Tear here, fold in half, seal and return<br />
<strong>Enrolment</strong> form<br />
First name:<br />
Surname:<br />
Address:<br />
Suburb: Postcode:<br />
Phone number:<br />
Email address:<br />
Date of birth: Gender: M F (please circle one)<br />
Please read and sign the following:<br />
1. I acknowledge that personal information provided by me and held by <strong>Wellington</strong> <strong>City</strong><br />
<strong>Council</strong> will be used for the administration of my <strong>Leisure</strong> <strong>Card</strong> application and ongoing<br />
use of that card.<br />
2. I have the right under the Privacy Act 1993 to request access to and correction of my<br />
personal information held by <strong>Wellington</strong> <strong>City</strong> <strong>Council</strong>.<br />
3. I agree to <strong>Wellington</strong> <strong>City</strong> <strong>Council</strong> notifying me of relevant event or programme<br />
opportunities relating to my <strong>Leisure</strong> <strong>Card</strong> membership.<br />
Yes No<br />
4. I agree that <strong>Wellington</strong> <strong>City</strong> <strong>Council</strong> can notify me of changes to <strong>Leisure</strong> <strong>Card</strong><br />
membership by email.<br />
Yes No<br />
I have included in this application:<br />
a copy of CSC or SGC or Green prescription<br />
proof of address<br />
a photo (either attached or emailed)<br />
Signed<br />
Office use only<br />
CSC# Expiry date<br />
SGC SG-CSC Address verified