Steel Bones Family Registration

If you need some urgent help or support, please ring the team on 03333 606930

Welcome to the Steel Bones Registration Form. You are registering for a FREE support pack, regular email newsletters and to get invitations to attend our events in person or online. We endeavour to ring everyone who registers to welcome them officially. We have amazing volunteers who also ensure every member is phoned at least once a year. If we cannot reach you we will leave a voicemail.

We handle your data with the greatest of care and we are registered with the Information Commission Office. Please note the emergency contact details will be held in strictest confidence and only accessed if you become unwell on one of our online or in person events.

By signing up to receive a Steel Bones pack you are also agreeing to abide by our Steel Bones Code and policies. PLEASE READ THIS HERE:
Steel Bones Family Agreement
Steel Bones Community Culture

Email Address*

First Name*

Last Name*

Gender

Address

Phone Number*

What is your favourite thing to do? Hobby/interest

Who is in your family? (Names and ages please)

Do any under 18's live with you?

Please state Amputee's Name (if different from above)

Please select the type of amputation

What Prosthetic Centre do you attend?

What hospital did the amputation happen in?

Whats the amputee's date of birth?

What date did the amputation take place?

What challenges are your family currently facing?

What is going really well for your family?

What way would you prefer us to contact you?

Please select any forms of communication we cannot use.
Phone
Email

Emergency Contact Details

How did you hear about Steel Bones?

Ethnicity