Max Card Application Form

Max Card is free to families living in Oxfordshire with disabled and additional needs children and young people aged 0-25. It has been funded by Oxfordshire County Council working in partnership with Action for Carers Oxfordshire.

The Max Card is a discount card for families. The scheme is designed to help families save money on days out at castles, zoos, bowling alleys and more. www.mymaxcard.co.uk

Please tell us about you (Parent/carer).

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 Town Post code

Email(Required)

Phone(Required)

Have you had a Max Card before?(Required)

Yes

Please tell us about your disabled or additional needs child/young person

Name(Required)

First Last

Date of birth(Required)

Nature of disability or additional need(Required)

School/college

If you are applying for a second child enter their details here

Name

First Last

Date of birth

Nature of disability or additional need

School/college

If you are applying for a third child enter their details here

Name

First Last

Date of birth

Nature of disability or additional need

School/college

Where did you hear about Max Card?

Signature

Enter your name here(Required)

Date(Required)

This application form will help us to collect information about suitability for a Max Card. We will only collect information that is needed, in line with data protection legislation. Our Privacy Policy explains why Action for Carers Oxfordshire collects your personal data, how we use it, who we may share it with, and sets out your rights in relation to your data. For further details of how your data is used and stored visit www.carersoxfordshire.org.uk/privacy-policy