Keycard Online Application Form

Skip to content | Skip to primary navigation - Accesskey = n | Skip to secondary navigation - Accesskey = r | Skip to search - Accesskey = k |

Text Size: A A A | Help | Online Services | Contact Us

East Lindsey District Council

A-Z of Council Services:

KeyCard Scheme

Keycard Online Application Form

If you wish to apply for a Keycard, please use the online application form below.

Please note:

If you are under 16, your parent or guardian will need to accompany you when you collect your card to sign the conditions of the Keycard Scheme.
Proof of any concessions should be taken with you when you go to collect your card.

For the online application form, fields in bold are mandatory fields.

Section 1: Contact Details

Title:
First Name(s):
Last Name:
Address:
Postcode:
Telephone:
Fax:
Email:
Mobile:
Date of Birth:
	dd/mm/yyyy
Age:
Join Date:
	dd/mm/yyyy
Is the above address in the East Lindsey area?:
Have you previously held a keycard?:

Section 2: Concessions If you are applying for a Concession Keycard, please tick one of the boxes below indicating which type of concession you qualify for:
	Over 60
	Job Seekers Allowance
	Working Tax Credit
	Incapacity Benefit
	Registered Disabled and in receipt of benefit
	Housing Benefit
	Income Support
	Student

Section 3: Swimming Season Tickets

Do you wish to purchase a swimsaver ticket ?:
If YES, for:

Section 4: Equal Opportunities What is your ethnic origin? Choose ONE section from A to E, and then tick the box to indicate your cultural background.

A White
	British
	Irish
Other white background (please specify):
B Mixed
	White and Black Caribbean
	White and Black African
	White and Asian
Other Mixed background (please specify):
C Asian and Asian British
	Indian
	Pakistani
	Bangladeshi
Other Asian Background (please specify):
D British or Black British
	Caribbean
	African
Other Black Background (please specify):
E Chinese or other ethnic group
	Chinese
Any other (please specify):

	Do you have access to the Internet?
	If YES, do you use it for local information?

Section 5: Collection Details

I want to collect my card from:

Section 6: Promotions and Special Offers Part of your scheme benefit is to receive details of special offers and promotions. Collated information may be passed to relevant parties.

	I do not wish to receive this service