ActiveLife Membership Form
Definition of Categories
Please note that you will be asked to pay for the remainder of the month at point of signing up. If you sign up for the membership on or after the 20th you will be expected to pay for the remainder of the month plus the full payment for the next month.
ActiveLife Individual – Monthly - £30.25 Annual - £363.00
Allows unlimited access to all facilities and activities within the scheme for individuals over 8.
ActiveLife Family – Monthly - £42.35 Annual - £508.20
Allows unlimited access to all facilities within the Active Life scheme for family members living in the same household. A family may contain up to 2 Adults over 18 and unlimited children under 18 living at the same address.
Budget Membership – £1 Per Activity
Allows individuals in receipt of certain benefits to access activities for £1 per visit. Proof of eligibility will be required every 6 months.
Contact Permission
Sign up for the Pickaquoy Centre’s monthly newsletter where you’ll get up-to-date information on new services, events and prize giveaways. From time to time, we may contact you with additional updates that we feel benefit you.
Yes please, I’d like to be kept up-to-date with What’s On at The Pickaquoy Centre.
No thanks, I do not want to be kept up-to-date with What’s On at The Pickaquoy Centre.
IMAGE: The first page is a scanned ActiveLife membership form showing the ActiveLife logo and the tagline “More people, more active, more often”, the “DEFINITION OF CATEGORIES” and “CONTACT PERMISSION” sections, membership prices and descriptions, newsletter consent checkboxes, and the logos and names “the pickaquoy centre” and “ORKNEY ISLANDS COUNCIL”.
The Direct Debit Guarantee
This guarantee should be detached and retained by the Payer.
This Guarantee is offered by all Banks and Building Societies that accept instructions to pay Direct Debits.
If there are any changes to the amount, date or frequency of your Direct Debit, The Pickaquoy Centre Trust will notify you not less than 15 days in advance of your account being debited or as otherwise agreed. If you request The Pickaquoy Centre Trust to collect a payment, confirmation of the amount and day will be given to you at the time of request.
If an error is made in the payment of your Direct Debit by The Pickaquoy Centre Trust or your Bank or Building Society, you are entitled to a full and immediate refund of the amount you paid by your Bank or Building Society.
If you receive a refund you are not entitled to, you must pay it back when The Pickaquoy Centre Trust asks you.
You can cancel a Direct Debit at any time by simply contacting your Bank or Building Society. Written confirmation may be required. Please also notify The Pickaquoy Centre Trust.
Direct Debit Instruction
Please fill in the whole form using a ballpoint pen and send it to:
The Pickaquoy Centre
Muddisdale Road
Kirkwall
Orkney
KW15 1LR
Account Details
Name(s) of Account Holder(s): ____________
Bank/Building Society account number: _________
Sort code: _________
Name and full postal address of your Bank or Building Society:
To the Manager Bank/Building Society
Address: ___________________
Postcode: __________________
Payment Details
Instructions to your Bank or Building Society to pay by Direct Debit.
Service User Number: 2 4 6 5 4 3
Reference Number: _______________
New Membership / New Details: ____________
Membership Type: _______________
Member Name: __________________
Instructions to your Bank or Building Society
Please pay The Pickaquoy Centre Trust Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee.
I understand that this instruction may remain with The Pickaquoy Centre Trust and, if so, details will be passed electronically to my Bank/Building Society.
Banks and Building Societies may not accept Direct Debit Instructions from some types of account.
IMAGE: The second page is a scanned Direct Debit form. It includes the detachable “The Direct Debit Guarantee”, the Direct Debit logo, the five guarantee statements, the heading “DIRECT DEBIT INSTRUCTION”, the payee address “The Pickaquoy Centre, Muddisdale Road, Kirkwall, Orkney, KW15 1LR”, service user number “246543”, blank reference and bank-account fields, membership details, signature and date fields, and the notice “Banks and Building Societies may not accept Direct Debit Instructions from some types of account.”
Your Details – Please Complete Form in Block Capitals
Main Member
Title: ________
Forenames: _________________
Surname: __________________
Date of Birth: __________________
Address: ___________________
Postcode: _________________
Telephone: ________
Mobile: __________
Email: ____________________
Additional Adult
Title: ________
Forenames: _________________
Surname: __________________
Date of Birth: __________________
Telephone: ________
Mobile: __________
Email: ____________________
Junior 1
Title: ________
Forenames: _________________
Surname: __________________
Date of Birth: __________________
Junior 2
Title: ________
Forenames: _________________
Surname: __________________
Date of Birth: __________________
Junior 3
Title: ________
Forenames: _________________
Surname: __________________
Date of Birth: __________________
Junior 4
Title: ________
Forenames: _________________
Surname: __________________
Date of Birth: __________________
Data Protection
The information we have about you will be held on computer or manual files by the Pickaquoy Centre Trust (PCT) and Orkney Islands Council (OIC) for the purpose of providing the services you are entitled to as a holder of the ActiveLife membership. The legal basis for processing this information is so the PCT and OIC can provide this public service. Only members of staff with a need to know will access this information. We also use the information you provide to help us understand what services are needed by residents and what the PCT and OIC can do to improve those services. Otherwise, we will only share your information if required to by law or if you give us your permission to do so.
IMAGE: The third page is a scanned member-details form with sections headed “YOUR DETAILS PLEASE COMPLETE FORM IN BLOCK CAPITALS”, “ADDITIONAL ADULT”, “JUNIOR 1”, “JUNIOR 2”, “JUNIOR 3”, “JUNIOR 4”, and “DATA PROTECTION”. It contains blank boxes for names, dates of birth, address, postcode, telephone, mobile and email details, followed by the displayed data-protection statement.
Budget Membership
To be eligible for a budget membership you must be in receipt of one of the following:
- Income Support
- Pension Credit
- Job Seekers Allowance
- Employment Support
- Universal Credit
- War Disability Pension
- Disability Living Allowance
- Personal Independence Payment
- Attendance Allowance
- Carers Allowance
We ask budget members to produce a dated award letter issued within the last 12 months. If you need a more recent letter, please call the benefit call line on 03456 00723.
Please note - Budget Members will be asked to show proof of eligibility every 6 months.
General Terms and Conditions of Use
Membership cards are non-transferable and any use other than by the member may result in immediate cancellation of the membership card.
All members must report to a customer services point and produce their membership card or membership card number, prior to participating in any activity, otherwise a full charge may apply.
It is the paying member’s responsibility to keep us informed of any changes to their contact details.
The Pickaquoy Centre Trust reserves the right to refuse any application for membership.
We reserve the right to add, remove or amend any activities or benefits within the membership scheme. All activities are subject to availability.
We reserve the right to charge additional fees for selected activities.
We reserve the right to amend prices at any time.
We reserve the right to amend our terms and conditions at any time.
A direct debit mandate must be completed and signed by the paying member before the membership can be purchased. Collection will be made on the 1st of every month.
If for any reason a facility, service or activity is closed or activities are cancelled for any period of time no refund will be given.
We operate a 6-hour cancellation policy. If you do not notify us of a cancellation, at least 6 hours in advance, then you will be charged the full Pay “n” Play fee at your next visit.
The membership scheme is available for the following: individuals over 8 years, or family of up to two adults over 18 years and unlimited children under 18 years of age. Proof of address may be required.
A digital photograph of all linked members, including children over 8, will be taken and stored with the membership details.
A Budget Membership option is available for anyone who is entitled to certain benefits. Please refer to www.pickaquoy.co.uk or www.orkney.gov.uk You will be required to provide evidence of your current status every 6 months.
Members will not be entitled to a refund for any part of their membership.
Please refer to the general conditions of use and admission policies for each individual facility.
If you wish to cancel your ActiveLife Membership, please notify us by emailing memberships@pickaquoy.com by the 20th of the month to cancel for the following month.
It is each user’s responsibility to disclose any relevant medical condition to the staff on duty at the time of play.
Use of single courts (for activities such as squash, badminton, tennis, table tennis & short tennis) are included in the ActiveLife membership. Participating non-members will be charged additionally.
A full induction is required to access any gym, strength & conditioning, functional training area and bouldering cave in any facility. Access to the climbing walls requires initial competency testing please contact the Pickaquoy Centre or KGS Sports Centre for details.
Budget Membership
- Allows users access to all activities for £1.
- You will be required to provide proof of eligibility every 6 months.
- Junior Budget members are entitled to Learn2Swim lessons at the equivalent of £1 per session, paid in advance by the start of each term.
Customer signature: ______________________
Date: ________
Staff signature: ______________________
Date: ________
Date of issue March 2019
Office Only
SCUBA No: ___________________
Membership card given: ________________
Receipt No: __________________
Photo Taken: ____________________
Amount Paid £____________________
Customer informed of cancellation policy: ___________
Membership taken out at: OIC SPORT & LEISURE
Customer completed Picky gym induction: ____________
Budget members only, date of award letter: ___________
Further Information
For more information about how the PCT use your information, please visit http://www.pickaquoy.co.uk/about-us/the-trust/. If you want to know more about how the Council will process your personal data and about your rights, visit http://www.orkney.gov.uk/Online-Services/privacy.htm
IMAGE: The fourth page is a scanned form containing the “BUDGET MEMBERSHIP” eligibility section, the “GENERAL TERMS AND CONDITIONS OF USE” numbered rules, customer and staff signature lines, the issue date “March 2019”, and an “OFFICE ONLY” section with fields for SCUBA number, receipt number, payment amount, membership card, photograph, cancellation-policy notification, induction, membership location, and award-letter date.