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Consent form

Name

First name

Last name
Registered address
Postcode
Date of Birth

DD/MM/YYYY
Telephone number
Mobile number
Email address

Are you a resident of Wigan Borough?
Which of the following statements are most relevant to you? (select all that apply)
A serving member of the Armed ForcesAn ex-serving member of the Armed ForcesA reservistAn immediate family member of any of the aboveA war widowA registered Carer of any of the above
What is you or your family members military service number? (if known)
When accessing council services in the past 12 months have you been asked the previous question?
Which council services do you currently use? (select all that apply)
Adult servicesChildren servicesEducation servicesWelfare and Benefit serviceWigan & Leigh HousingLeisure servicesNoneOther
Please state if selected other

We are seeking to identify armed forces families across the borough. Can you describe your Armed Forces family?
Please describe in detail what your current needs are
Do you have any contact with any other charities or services?
Where did you hear about this consent form or our Armed Forces Team?

Please state if an agency or service, a friend/family or if through your own search.

Declaration
By submitting this form you give your consent for us to record your details and responses for the purposes below:
- Our records are as up to date as possible.
- We can effectively signpost you or a family member to relevant services or support.
- We can work with you to meet any needs. In the future we may want to share your information, for the same purposes as outlined above, with partner agencies such as health and other organisations who can offer advice and support.
- You will always be consulted before passing your personal information outside of Wigan Council.
Please confirm you hereby give consent
Yes, I give consent
Name

First name

Last name
If you do not want us to record/share your information this will not affect the services you or your family will receive in any way. You can withdraw your consent at any time by contacting the Armed Forces Team. This will be complied with unless there is a requirement to continue to process this information under the General Data Protection Regulation 2018.

All the information we collect will be confidential and held in accordance with the General Data Protection Regulation 2018. We will not process information for any other purposes than outlined above.

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