Membership Application Form

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Personal Details

Name:*

First Last

Address:*

Street Address City Province Postal Code

Phone:*

Type:*

Home

Cell

Work

Email:*

Birthdate*

DD slash MM slash YYYY

I identify my gender as:*

Female

Male

Non-binary

Other

Decline to answer

Please specify:*

Number of Children*

Please enter a number greater than or equal to 0.

Preferred Language:*

Please specify:*

Program(s) Attending:*

Adult Day Program

Employment and Career

Volunteer

Childcare

Settlement

Family

Young Adult

Youth

Other

Please specify:*

Contact Preference(s):*

Phone

Text

Emergency Contact

Name:*

Full Name

Relationship:*

Contact Phone:*

Waiver Release

Waiver:*

I agree that I, the undersigned, will follow all reasonable instructions and directions of the staff, leaders,and instructors duly appointed by the Association of Neighbourhood Houses (ANHBC) in connection with the operation of all SVNH programs. I hereby release, and forever discharge ANHBC and its agents or volunteers, of and from all manner of action, cause of actions, claims and demands of whatever nature which result from any accidental injury, loss or expense sustained, arising out of or in any way connected with participation in any program, or attendance at any location operated by ANHBC.

Signature*

Photo Permission Release

Release:*

During SVNH events or programs, you may be photographed or filmed for the purpose of capturing memories and promotion for South Vancouver Neighbourhood House (e.g. newsletter, website, posters or brochures, SVNH Facebook page or slideshows, and funder reports). Therefore we ask for your permission to use photos or film for these purposes.

I give permission for SVNH to use photos or film taken during the course of my participation in this program or event.

I DO NOT give permission for SVNH use photos or film taken during the course of my participation in this program or event.

IRCC Member

Are you an IRCC client or participating in an IRCC funded program?*

Yes

South Vancouver Neighbourhood House Membership

Which type of membership do you wish to purchase?*

Child/Youth Membership

Senior Membership

Adult Membership

Family Membership

Which type of membership?*

Child/Youth Membership

Senior Membership

Adult Membership

Family Membership

Family Members Personal Details

Please provide personal details for family members you are registering:

First Family Member:

Name*

Full Name

Relationship to you:*

Date of Birth*

MM slash DD slash YYYY

Phone*

Email*

Add another family member?*

Yes

Second Family Member:

Name*

Full Name

Relationship to you:*

Date of Birth*

MM slash DD slash YYYY

Phone*

Email*

Add another family member?*

Yes

Third Family Member:

Name*

Full Name

Relationship to you:*

Date of Birth*

MM slash DD slash YYYY

Phone*

Email*

Add another family member?*

Yes

Fourth Family Member:

Name*

Full Name

Relationship to you:*

Date of Birth*

MM slash DD slash YYYY

Phone*

Email*

Add another family member?*

Yes

Fifth Family Member:

Name*

Full Name

Relationship to you:*

Date of Birth*

MM slash DD slash YYYY

Phone*

Email*

Add another family member?*

Yes

Sixth Family Member:

Name*

Full Name

Relationship to you:*

Date of Birth*

MM slash DD slash YYYY

Phone*

Email*

Association of Neighbourhood Houses of British Columbia Membership

Association of Neighbourhood Houses of British Columbia (ANHBC) is an umbrella organization of eight Neighbourhood Houses and one outdoor camp including Alexandra, Cedar Cottage, Frog Hollow, Gordon, Kitsilano, Marpole, Mount Pleasant, and South Vancouver Neighbourhood Houses, and, Sasamat Outdoor Centre. ANHBC membership dues are $2 per year. There are many benefits to membership with ANHBC including voting privileges at the Annual General Meeting, events and news from ANHBC Neighbourhood Houses and Special notices of timely information.

ANHBC membership is optional and will not affect your entitlement to any benefits and privileges under your South Vancouver Neighbourhood House membership.

Would you like to become a member of ANHBC?*

Yes, I would like to become an ANHBC member

No, I would not like to become an ANHBC member

E-newsletter Sign-up

E-Newsletters offer updates on SVNH programs and highlights around the community. E-News are sent out by staff quarterly, and you have the ability to unsubscribe at any time.

Add me to email list:*

Yes

SVNH and ANHBC Membership Fees Total

You will be charged this amount:

Method of Payment

Select payment method:*

Cash or Check

Credit Card

SVNH staff will contact you via phone, text or email to set an appointment for payment.

Credit Card*

Card Details

Cardholder Name

Personal Details

Emergency Contact

Waiver Release

Photo Permission Release

IRCC Member

South Vancouver Neighbourhood House Membership

Family Members Personal Details

Association of Neighbourhood Houses of British Columbia Membership

E-newsletter Sign-up

Method of Payment

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