Membership Form

Please print and bring to shed. NB: The minimum age for membership of the Kyneton Men’s Shed Inc. is 18 years

Name: …………………………………………………………………………………………………………………………….

Address: ………………………………………………………………………………..………………………….

………………………………………………………………………………….…………Postcode: ……………

Date of Birth: DD/MM/YYYY …………./……………./………………

Telephone: Home: ………………………………….. Mobile: ………………….…………………….

Email: ……………………………………………………………………………………………………………………………

Emergency Contacts:

Name Relationship Home Phone Mobile Phone

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How did you get to know about the Kyneton Men’s Shed and / or who introduced you ?

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Have you any health conditions or are you on any medication that may affect your capacity to operate machinery? YES / NO

If yes, please provide brief details below.

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Occupation (Past or Present):

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Do you have qualifications in your area of expertise? YES / NO

If yes, please list your qualifications below.

Qualification Expiry Date (if applicable)

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What are your particular areas of interest in the Shed? (e.g., woodwork, metalwork, small engines, companionship, other.)

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Are you willing to mentor others using your areas of skills and interest?

YES / NO If yes, please provide brief details.

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Do you acknowledge and agree that membership to the Kyneton Men’s Shed, including use of its facilities and equipment, does not become effective until payment of your membership subscription has been received by the Shed? YES / NO

Do you acknowledge and agree that you are not entitled to use the Shed’s facilities & equipment until you have attended a Shed Induction? YES / NO

Applicant’s Declaration

In becoming a Member of the Kyneton Men’s Shed Inc. (KMS), I understand and agree:

*KMS will make every effort to maintain a safe environment in the Shed for its members, visitors, contractors, agents and others lawfully utilising the Shed and its facilities (“patrons”);
*KMS and its representatives are not responsible (and do not accept responsibility) for:
a) the personal health, safety and well-being of patrons whilst in the Shed, utilising the facilities and / or participating in projects or other activities of CMS;
b) the loss or damage of any patron’s personal items (including mine) taken to or from the Shed or any other place at which KMS project or activity is being carried on; and
c) any personal injury including death of any patron whilst at the Shed or any other place at which KMS project or activity is being carried on or whilst utilising its facilities and / or participating in any project or other activities of KMS;
d) to release KMS and its representatives from any claim by me and / or my estate for the loss or damage to any personal item and / or injury I may suffer whilst in or at the Shed, utilising its facilities and / or participating in any project or other activity of KMS;
e) to abide by the policies and procedures of KMS and act in a safe and respectful manner at all times whilst I am in or at the Shed, utilising its facilities and / or participating in projects or other activities of KMS and I will have due care and regard to all other patrons working near or around me whilst in or at the Shed or participating in any project or activities of KMS.

Applicant’s Signature: ………………………………………………..….. Date: ……………………

Proposer’s Name: ……………………………………………………………. Date: ……………………

Proposer’s Signature: ………………………………………………………..….

Seconder’s Name: ……………………………………………………………. Date:……………………

Seconder’s Signature: ………………………………………………………..….