Join the network and apply for or renew a Max Card

Live article 59337 CHILDRENWITHDISABILITIESMAXCARDVALIDATION

Details of child
1. Name
  1. Child's first name*
  2. Child's last (family) name*
2. Child's date of birth (DD/MM/YYYY)*
3. Child's address
  1. If you are applying for a Max Card, it will be sent to this address.
  4. Postcode*
  6. Select your address*
  7. Address
    
    You have selected:
    
    Address
    
    Change address
4. Child's school
5. Gender
  
  Male
  
  Female
  
  Prefer not to say
6. Ethnicity
Child's condition or disability
1. Has your child been diagnosed with any conditions or disabilities*
  
  Yes
  
  No
2. Please list all conditions or disabilities your child has been diagnosed with
3. Is your child being assessed for any conditions or disabilities?*
  
  Yes
  
  No
4. Please list all conditions or disabilities your child is being assessed for
Support services
1. What support services does your child use, and how frequently?
  For example, services may include: Occupational Therapy, Speech Therapy, Physiotherapy, Child Care, Voluntary / Charity Organisations, Mental Health Service, Children with Disabilities Social Work Team, Children and Young People's Service (health) etc. Frequency may be: daily, weekly, monthly.
2. What other services do you feel would be useful to you?
  This includes activities you would like your child to take part in.
Child's main carer
2. Your name
  1. Title*
  2. First name*
  3. Last (family) name*
3. Your email
  1. Email address*
  2. Confirm email address*
4. We will send a confirmation of your application to this email address.
5. I am happy to get emails about local events and things to do for children with disabilities (please note, most information from the Network is provided via email)
6. Phone number
7. We will only call you if we need more information to process your application form.
9. Does this carer live at the same address as the child?*
  
  Yes
  
  No
Carer's address
4. Postcode
6. Select your address
7. Address
  
  You have selected:
  
  Address
  
  Change address
Second carer
1. Would you like to add details of another carer?*
  
  Yes
  
  No
2. Second carer details
  1. Your name
    
    Title
    
    First name
    
    Last (family) name
  2. Your email
    
    Email address
    
    Confirm email address
  3. Phone number
  4. Does this carer live at the same address as the child?
    
    Yes
    
    No
Second carer's address
3. Postcode
5. Select your address
6. Address
  
  You have selected:
  
  Address
  
  Change address
Max Card
1. What is a Max Card?
  
  Max Cards give you free and discounted to entry to over 1,500 cultural and leisure attractions, many of which are in South Tyneside and the North East.
  
  To be eligible for a Max Card, your child needs to either:
  
  have a diagnosed condition / disability
  
  currently being assessed for conditions / disabilities
  
  Find out more about Max Cards.
2. Would you like to apply for a Max Card?
  
  Yes
  
  No
3. Have you had a Max Card before?
  
  Yes
  
  No
Max Card survey
1. Please let us know how you have used your Max Card in the past. Select the places that you have used your Max Card and let us know how many times.
2. Swimming and gym
  
  Hebburn Central swimming pool
  
  Haven Point swimming pool
  
  Jarrow Pool
3. Tyne and Wear
  
  Arbeia Roman Fort
  
  The Ark at Crawcrook (Ryton)
  
  BALTIC Centre
  
  Bedlam Lasertag (Newcastle)
  
  Bedlam Paintball (Newcastle)
  
  Bedlam Lasertag (Tyneside)
  
  Bedlam Paintball (Sunderland)
  
  Blue Reef Aquarium
  
  Centre for Life
  
  Dance City
  
  Discovery Museum
  
  Eldon Leisure Centre
  
  Escape Key (Newcastle)
  
  Gibside
  
  Go Ape (Maften Hall)
  
  Gosforth Pool
  
  Great North Museum
  
  Hatton Gallery
  
  Jarrow Hall
  
  Laing Art Gallery
  
  Live Theatre
  
  Mister Twisters
  
  National Glass Centre
  
  Nationwide Paintball (Newcastle)
  
  NE Land, Sea, Air Museum
  
  Never Give Up (Newcastle)
  
  Newcastle Castle
  
  Newcastle Climbing Centre
  
  Northern Stage
  
  River Escapes
  
  Segedunum Roman Fort
  
  Seven Stories
  
  South Shields Museum
  
  Splatmaster (Newcastle)
  
  Splatmaster (Sunderland)
  
  Squiggles N Giggles
  
  Stephenson's Railway Museum
  
  Sunderland Bowl
  
  Sunderland Museum and Winter Gardens
  
  Team Sport (Newcastle)
  
  The Customs House
  
  The Globe Gallery
  
  Shipley Art Gallery
  
  Tyneside Cinema
  
  Washington F Pit
  
  Washington Old Hall
  
  Washington Wetlands
  
  West Denton Pool
  
  The Word, The National Centre for the Written Word
  
  Virgin Experience Days (Newcastle)
  
  Virgin Experience Days (North East)
4. Northumberland
  
  Alnwick Castle
  
  Alnwick Gardens
  
  Bailiffgate Museum
  
  Bamburgh Castle
  
  Bedlam Paintball (Hexham)
  
  George Stephenson's Birthplace
  
  Heatherslaw Corn Mill
  
  Hexham Old Gaol
  
  Lady Waterford Hall
  
  Morpeth Chantry Bagpipe Museum
  
  Northumberland Zoo
  
  Seaton Delaval Hall
  
  SplatMaster Hexham
  
  Woodhorn Museum
5. Tees Valley
  
  Bedlam Paintball (Middlesborough)
  
  Bedlam Lasertag (Scotch Corner)
  
  Bedlam Paintball (Scotch Corner)
  
  Captain Cook Museum
  
  Cleveland Ironstone Mining Museum
  
  Dorman Museum
  
  Guisborough Museum
  
  Hartlepool Art Gallery
  
  Hartlepotz
  
  Hollywood Bowl (Stockton)
  
  Juvenate Health and Leisure Club (Middlesborough)
  
  Kirkleatham Museum
  
  Nationwide Paintball (Middlesborough)
  
  The Pottery Loft (Stockton)
  
  RSPB (Saltholme)
  
  Splatmaster (Scotch Corner)
  
  Tweddle Farm
  
  Two Hoots
  
  Zetland Lifeboat Museum
6. County Durham
  
  Adventure Point (Darlington)
  
  Adventure Valley
  
  Bedlam Paintball (Darlington)
  
  Bedlam Paintball (Durham)
  
  Binchester Roman Fort
  
  The Bowes Museum
  
  Botanic Gardens
  
  Beamish Museum
  
  Beamish Wild
  
  Bishop Auckland Table Tennis Centre
  
  Cherryburn (Stocksfield)
  
  Crook Hall and Gardens
  
  Durham Cathedral
  
  Darlington Railway Museum
  
  Darlo Play Plaza
  
  Holmside Park
  
  Killhope Lead Mining Museum
  
  Krazy Kingdom (County Durham)
  
  Nationwide Paintball (Darlington)
  
  Shildon Railway Museum
  
  Oriental Museum
  
  ROF59 (Newton Aycliffe)
  
  Splatmaster (Durham)
  
  Weatherriggs Animal Rescue
7. Please list any attractions outside of the North East which you have visited with your Max Card.
Privacy notice
1. I have read and agree to the [privacy notice]*

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