Request to hold copy of discount or companion card
Staff initial:
Your Details
Name:
Surname:
Address:
Phone:
Email:
Date of birth:
Calendar
Emergency contact details
Name:
Surname:
Phone:
Confirmation
I authorise Cockburn ARC to keep a copy of my discount or companion card on record and understand:
It is recommended I bring my card with me every visit as it will be make the process quicker
On the occasions I do forget my card, I must see reception staff upon my visit so the card on record can be sighted
It is my responsibility to ensure the card on record is kept up to date
Upload front of discount or companion card:
Upload back of discount or companion card: