Download - Burnley Borough Council

application form
Name:
Address:
Space Card No:
Renewal Yes No
Do you want to include your children
(They must also be Space Card holders)
Child Application 1
Name:
Space Card No:
Child Application 2
Name:
Space Card No:
Child Application 3
Name:
Space Card No:
Child Application 4
Name:
Space Card No:
Do you want to use your Passport to Leisure at St Peter’s
Crèche, Burnley Mechanics, Towneley Golf Course or for
discount on a Towneley annual car park pass
Yes No
If yes, please supply a passport
sized photo. A separate pass will be
issued and sent to you.
I have read, understood and accept the Recreation
Passport terms and conditions, and confirm that the
information I have provided is accurate.
SIGNATURE:
Date:
Don’t forget to bring proof of benefit entitlement and your
address such as a household utility bill or bank statement.
terms & conditions
1. Passport to Leisure is available only to residents of the
Borough of Burnley.
2. All applicants MUST register on the Leisure &
Recreation Services Space Card scheme.
3. Parents who are entitled to a Passport to Leisure may
also apply to include their children on the scheme
(each child must hold an individual Space Card)
4. Passport to Leisure is only valid if presented by the
named card holder, whose photograph must be
recorded.
5. The card must be presented to claim the Passport to
Leisure discount.
6. Burnley Council reserves the right to refuse issue of a
Passport to Leisure and to withdraw if misused.
7. The information you provide will be held on computer
and paper files and will not be given or sold to any
other organisations without your permission.
8. If the pass holder moves out of the borough or they no
longer fall within the categories stated above, the pass
becomes invalid and MUST be returned.
9. All application details will be randomly checked and
verified with other council service units.
10. Passport to Leisure passes are valid for a period of
12 months, after which time you will be required to
reapply.
how & when to apply
Bring your completed application form to:-
• St Peter’s Centre, Church Street, Burnley
t: 01282 664444
Mon to Fri, between 10am and 2.30pm
• Padiham Leisure Centre, Park Road, Padiham
t: 01282 664588
Mon to Fri, between 10am and 2.30pm
• Contact Burnley, Parker Lane, Burnley
t: 01282 425011
Mon, Tues, Thurs, Fri between 9am and 5pm
Wed between 10am and 5pm
swimming • squash • badminton • trampolining • gymnasiums • yoga • gymnastics• group fitness • saunas
the answer is
Burnley Council’s Health & Fitness Membership
Designed by Graphics, Burnley Borough Council July 2007. jb_2271
passport to
leisure
discounts for
Burnley residents...
• on a low income
• entitled to benefits
• full time students
at Burnley Council leisure facilities

what is it
The Burnley Council Passport to Leisure Scheme
provides Burnley borough residents on a low income
access to leisure facilities and activities at reduced
prices for themselves and their children.
The passport can be used at:
• St Peter’s Leisure Centre
Church Street, Burnley BB11 2DL
t: 01282 664444
• Padiham Leisure Centre
Park Road, Padiham BB12 8ED
t: 01282 664588
• Spirit of Sport
Ormerod Road, Burnley BB11 3AA
t: 01282 430493
Passes can be used at any time, see the general price
list (available from the leisure centres) for details of
discounted prices.
• Burnley Mechanics*
Manchester Road, Burnley BB11 1JA
t: 01282 664400
You can use your pass at selected events -
please ring or call in for details.
• Towneley Municipal Golf Course*
Todmorden Road, Burnley
t: 01282 438473
• Towneley car park - for discount on annual pass*
Todmorden Road, Burnley
* A separate pass is required if you wish to use your
Passport to Leisure at St Peter’s Crèche, Burnley
Mechanics, Towneley Golf Course, or for discount on
a Towneley car park annual pass, see the application
form for details.
who qualifies
People entitled to:
• Housing Benefit
• Council Tax Benefit
(These details will be randomly checked and verified with
other council service units)
People entitled to the following benefits
may also be eligible:-
• Working Tax Credit (nb: Not Child Tax Credit )
• Pension Credit Guaranteed Credit
• Disabled Person’s Tax Credit.
Proof required: Award notice letter and recent bank
statement showing the benefit paid in.
• Income Support
• Incapacity Benefit
• Disability Living Allowance
Proof required: Award notice letter and recent bank
statement showing the benefit paid in or current
allowance book
• Disabled Person’s Bus Pass
Proof required: Valid Disabled Person’s Bus Pass
• Job Seekers Allowance
Take this form with you when you next sign on and ask
a member of staff to stamp the ‘qualifying stamp’ box
You will need to bring proof of your benefit
entitlement, along with proof of address such as a
household utility bill or bank statement, to process
your application.
Students are also eligible
You must be in full-time further education
Please bring a full-time student card OR ask a member
of staff to stamp the ‘qualifying stamp’ box
APPLICANTS MUST ALSO BE A SPACE CARD HOLDER
A Space Card is a FREE customer registration card
for Burnley council leisure centres. Call into St Peter’s
Leisure Centre or Padiham Leisure Centre to obtain
yours.
for official use only
I certify that the named applicant qualifies for or is
in receipt of the following benefit
For those claiming Job Seekers Allowance or
full time students:
The applicant is either in
receipt of or qualifies as:
Job Seekers Allowance:
Income based
Job Seekers Allowance:
Contributory based
A full time student
Proof of benefit entitlement given
Proof of address given
Official’s signature:
Print name:
Date:
Site:
Received by:
Date:
Entered on system by:
QUALIFYING
STAMP BOX
swimming • squash • badminton • football • cricket • trampolining • gymnasiums • yoga • gymnastics • netball • group fitness • saunas, steam & spa pool • golf