Neuadd St Catwg Community Hall, Church Road, Gelligaer CF82 8FW Tel: 01443 834022

Cyber Caf Membership Application Form

Please complete all sections below in black ink. Return the form to Neuadd St Catwg Community Hall for form to be processed and card produced. Full name Date of Birth Home address

Contact telephone number e-mail address In case of an emergency Emergency Contact Name Emergency Contact tel Relation to applicant Details of any medical conditions

Daytime: Evening:

Membership rules: Membership cards cost 1.00 per person. If membership card is lost, a charge of 2.00 will be made for a replacement. Members are required to bring membership card with them on every visit to the Hall. A photo will be taken to be used on membership card only & will not be used for any other purpose. Members will sign in & out when entering & leaving the building Members will follow the Code of Conduct when using Cyber Caf (displayed in Cyber Caf) Members will follow the rules of the Internet Acceptable Use Policy when using Cyber Caf (displayed in Cyber Caf) During term time, no under 18s before 4:00pm During school holidays, over 18s get priority before 4:00pm During busy periods in the Cyber Caf, a queuing system will be in operation and users will be limited to 15mins on a computer at a time.

I agree to abide by the membership rules. I understand that if any of the rules are broken then I can lose my membership and disciplinary measures may be taken. Signature_______________________ Date__/__/____

If applicant is under 18 years of age, then parent/guardian must also sign below to give permission for the applicant to become a member. Signature_______________________ Date__/__/____ Relationship to applicant ____________________
Office use only Membership no: Card produced: