LeisureCARD
Wellington City Council’s Leisure Card allows people on low incomes and people who meet other criteria discounted entry into a range of recreation and leisure services.
Fold in half, seal and return
You qualify for the card if you are a Wellington City resident and:
• a Community Services Card holder or • on the Invalid’s or Sickness benefit or • a recent migrant within the last six months of entry stamp in passport with a Resident Visa or • on the Green Prescription (GRx) scheme or • a Wellington City Council city housing tenant or
CSWCC97914
Freepost 2199 Parks, Sport and Recreation (SECC01) Wellington City Council PO Box 2199 Wellington 6140
• a SuperGold Card holder. If you are not eligible please pass this on to someone who is.
Wellington.govt.nz
WHAT YOU NEED TO INCLUDE WITH YOUR LEISURE CARD ENROLMENT FORM
1. ONE of the following: a photocopy of both sides of your Community Services (CSC) or SuperGold card (SGC) OR OR OR Green prescription referral form a recent letter from WINZ, that shows your name, address and client number photocopy of entry date stamp in Passport and Resident Visa. Photocopy or tear the top off a bill showing your name and address.
ENROLMENT FORM
First name Surname Address Suburb Phone number Mobile Email address Date of birth
Tear here, fold in half, seal and return
Postcode Ethnicity
2. Proof that you live in Wellington 3. Photo
Gender M
F (please circle one)
Please read and sign the following:
1. I acknowledge that personal information provided by me and held by Wellington City Council will be used for the administration of my Leisure Card application and ongoing use of that card. 2. I have the right under the Privacy Act 1993 to request access to and correction of my personal information held by Wellington City Council. 3. I agree to Wellington City Council notifying me of relevant event or programme opportunities relating to my Leisure Card membership. Yes No 4. I agree that Wellington City Council can notify me of changes to Leisure Card membership by email. Yes No I have included in this application (please tick): proof of address a photo attached emailed And one of the following: a copy of Community Services Card (CSC) or Super Gold Card (SGC) or Green Prescription a copy of entry date stamp in Passport and Resident Visa a recent letter from WINZ that shows your name, address and client number. Signed
Office use only CSC# SGC GP Address verified Application verified at
1. Send a head and shoulders photo of yourself with your enrolment form. OR 2. You may email your photo to leisurecard@wcc.govt.nz Please put your name as the subject line. OR 3. You can get your photo taken for your Leisure Card application at these Wellington City Council facilities: Wellington Regional Aquatic Centre Kilbirnie Crescent Kilbirnie Recreation Centre Kilbirnie Crescent Freyberg Pool and Fitness Centre Oriental Parade Karori Pool Donald Street Tawa Pool Davies Street 9–10.30am, Mon–Fri 1–3pm, Mon–Fri 12noon–2pm, Mon–Fri 10am–12noon, Mon–Fri Anytime during opening hours Mon–Sun
Wellington City Council Service Centre 9–10.30am, Mon–Fri Wakefield Street Smart Newtown (next to Newtown Library) Keith Spry Pool (Johnsonville) Frankmore Ave 10am–2pm, Mon–Fri Anytime during opening hours Mon–Sun
Date
Expiry date RM by
CH Date 