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Join the Children with Disabilities Network and apply for a Max Card

  1. Details of child
    1. Name
    2. Child's address
      1. If you are applying for a Max Card, it will be sent to this address.
      2. Address

        You have selected:

        Address

        Change address

    3. Gender
  2. Child's condition or disability
    1. Has your child been diagnosed with any conditions or disabilities *
    2. Is your child being assessed for any conditions or disabilities? *
  3. Support services
    1. For example, services may include: Occupational Therapy, Speech Therapy, Physiotherapy, Child Care, Voluntary / Charity Organisations, Mental Health Service, Children with Disabilities Social Work Team, Children and Young People's Service (health) etc. Frequency may be: daily, weekly, monthly.
    2. This includes activities you would like your child to take part in.
  4. Child's main carer
    1. Your name
    2. Your email
    3. We will send a confirmation of your application to this email address.
    4. We will only call you if we need more information to process your application form.
    5. Does this carer live at the same address as the child? *
  5. Carer's address
    1. Address

      You have selected:

      Address

      Change address

  6. Second carer
    1. Would you like to add details of another carer? *
    2. Second carer details
      1. Your name
      2. Your email
      3. Does this carer live at the same address as the child?
  7. Second carer's address
    1. Address

      You have selected:

      Address

      Change address

  8. Max Card
    1. What is a Max Card?

      Max Cards give you free and discounted to entry to over 1,500 cultural and leisure attractions, many of which are in South Tyneside and the North East.

      To be eligible for a Max Card, your child needs to either:

      • have a diagnosed condition / disability
      • currently being assessed for conditions / disabilities

      Find out more about Max Cards.

    2. Would you like to apply for a Max Card?
    3. Have you had a Max Card before?
  9. Max Card survey
    1. Please let us know how you have used your Max Card in the past. Select the places that you have used your Max Card and let us know how many times.
    2. Swimming and gym
    3. Tyne and Wear
    4. Northumberland
    5. Tees Valley
    6. County Durham
  10. Privacy notice

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