Steel Bones Family Registration

Welcome to the Steel Bones Family Registration Form. The enables you to register with us for a FREE family pack and attend our events in person or online. Please note the emergency contact details will be held in strictest confidence and only accessed when if you became unwell on one of our online or in person events but also necessary in case we were unable to reach you.

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

Address

What is your favourite thing to do? Hobby/interest

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

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

Please enter the type of amputation

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?

Phone Number

Emergency Contact Details

How did you hear about Steel Bones?

What Prosthetic Centre do you attend?

What hospital did the amputation happen in?