Just complete this form and send in to Kids Can Achieve at 29 Pinner Green, Middx, HA5 2AF

It's only £1 a year. Or you can choose to give more! You might wish to make a monthly, annual or one-off donation of your choice.

How your membership can help children with special needs and their families:

• £50 could help towards providing a residential trip / therapy workshop for the children
• £20 gets a child on a play scheme / outing for a day
• £15 will pay for 1 hour's outreach support or a sport / activity session
• £10 will buy a day at a youth holiday scheme
• £5 can buy games, toys, books or equipment

Name .......................................................................................................................

Address....................................................................................................................

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Tel .......................................................Email ...........................................................

I enclose my £1 payment for one year’s membership

I also wish to make a regular donation of:

£10 annual / monthly ......... £50 annual

£15 annual / monthly.......... £100 annual

£20 annual / monthly ......... Other £_______ annual/ monthly

I wish to make a one-off donation of £______________

Please make cheques payable to Kids Can Achieve.


If you wish to pay by Standing Order, please use the form below and return it to your bank/building society.

Thank you.

Regular standing order form

Please complete the form below and return it to your bank so that they can process payments.

Your name & address:

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To your bank (Bank/Building Society name and address):
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Your account no: ......................................................Sort code: .......................................

Please pay to Alliance & Leicester Commercial Bank, Bootle, Merseyside GIR 0AA for the account of:
Kids Can Achieve (Account No. 602247489) (Sort Code 72-00-00):

Amount (in words & figures): The sum of £ ............................................................... (figures)

..................................................................................................................................(words)

on the …….……..… day……..………. month……..…….. year and a like sum each
year/quarter/month* until further notice (optional).


Signed: ..................................................Print:.............................................. Date: ........................

PLEASE NOTE THAT THIS REPLACES ANY PREVIOUS
STANDING ORDER FORMS

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How you can increase your donation at no extra cost to you!
For every £1 you donate to KCA, we can reclaim the tax through the Gift Aid scheme, increasing your donation to £1.28. There's no extra cost to you - all you have to do is make a Gift Aid Declaration. You just confirm you are a UK tax payer and that you are happy for us to reclaim the tax. All donations qualify - large or small, regular or one-off, and whatever the method of payment.
I want KCA to treat all donations I have made since 6 April 2000, and all donations I make from the date of this declaration as Gift Aid donations, unless I notify you otherwise. I confirm that I am a UK tax payer and I am resident in the UK for tax purposes.

Signed:................................................... Date: ..........................................