The WLCT Lifestyle +1 Card allows
free admission for carers, who are
supporting a person who needs
additional help and assistance when
using the swimming pool or gym.
E
L
Y
T
S
LIFE +1
CARD
To apply you will need to meet one or
more of the following criteria:
• Work for a health and social care organisation
• Work for a person who requires additional help or
assistance when using WLCT facilities
• Be a registered informal carer
Proof required is the following:
To find out more call:
01942 488 481
• Letter from care organisation giving evidence
of employment
• Evidence of working for someone who
is in receipt of disability living allowance,
personal independence payments or
attendance allowance
• Evidence of working for someone who is
registered blind
• Hold a carer discount card issued by Wigan &
Leigh Carers Centre
www.getactivewiganandleigh.co.uk
For just £1.60 per year you can swim and use the gym for free
while in a caring role, and at the reduced rate at other times.
To apply for your Lifestyle card complete this application form
and take to any WLCT leisure centre or pool.
1. PERSONAL DETAILS
This section should be completed in full. Please write clearly in BLOCK CAPITALS.
Title: Mr
Mrs
Miss
Ms
Mstr
Other:
First name:
Last name:
Address:
Postcode:
Tel. Home:
Work:
Mobile:
Email:
Telephone
Please tick preferred method of contact:
Date of birth
/
/
Email
(e.g. for 7th March 1975 enter 07/03/75)
Gender: Male Female
Do you consider yourself to have
a disability or long term health issue?
e.g. asthma, diabetes:
Yes No
Are you registered disabled?
Yes No
2. WHAT IS YOUR EMPLOYMENT STATUS?
Working full time
Receiving benefits
Working part time
Retired
Self-employed
overnment supported training
G
scheme
Long term sick
Full-time student
Unemployed
Looking after home/family
Other
3. WHICH ONE OF THE FOLLOWING DESCRIBES YOUR ETHNIC ORIGIN?
Please tick ONE box only:
Asian or
Black or
Asian British
Black British
White
Mixed
British White
Indian
Caribbean
Irish
White & Black
Pakistani
African
White Other
Other Mixed
Bangladeshi
Black Other
Asian Other
Chinese or other ethnic group
Chinese
Other
4. SUPPORTING ROLE
Please tick one of the following boxes.
Support Worker
Name of organisation:
Personal Assistant
Registered carer
Other. Please give more details:
5. DATA PROTECTION
In compliance with the Data Protection Act 1998, all personal information is
treated confidentially and not passed on to other organisations.
Tick here, if you do not wish to receive discounts, offers and information from WLCT.
6. DECLARATION
I certify that the information provided is correct. I understand and accept
the terms and conditions of use.
Signature:
Date:
Signature of parent or guardian if under 16:
Date:
* Please read Terms & Conditions when applying
For office use only
Card issued by:
Date card issued:
Data inputted by:
Card no:
Issuing site:
Evidence Type:
WLCT Active Living offers extra support and specialised sessions for people with medical
conditions, disabilities, dementia and mental health conditions.
Active Living Team
WLCT, Robin Park Sports Centre,
Loire Drive, Wigan WN5 0UL
Tel: 01942 488 481
Email: [email protected]
This scheme runs in the following leisure centres:
Ashton Leisure Centre
Leigh Indoor Sports Centre
Old Road
Ashton, Wigan WN4 9TP
Sale Way, Leigh Sports Village
Leigh WN7 4JY
Tel: 01942 720 826
Tel: 01942 487 800
Hindley Sports Centre
Robin Park Sports & Tennis Centre
Tel: 01942 253 142
Tel: 01942 828 550
Howe Bridge Sports Centre
Wigan Life Centre
Eckersley Fold Lane
Atherton, Manchester M46 0PJ
College Avenue
Wigan WN1 1NJ
Tel: 01942 870 403
Tel: 01942 489 611/489 612
Mornington Road
Hindley, Wigan WN2 4LG
Loire Drive
Newton, Wigan WN5 0UL