EmailMe Form - Scout Personal Details

Child's First name *

Child's Surname *

Child's Date of Birth *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Parent/Guardian Name *

Parent/Guardian Name

Parent(s) Email

Home Telephone Number

Parent(s) Mobile Number

School *

Religion

Medical/Health Details

Any information you give here will be kept strictly confidential and will only be used to ensure your child gets the most out of Scouting.

Medical Details

Physical/Learning Needs

Special Dietary Needs

I give permission for my child to be given Kapol (or similiar) *

Yes

No

I give permission for my child to be given sun cream/ repellents and is not allergic to any particular type. *

Yes

No

Doctors Details

Dr's Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

Emergency Contact Details

Please give us the name of contact details of a friend/relative who we can contact in an emergency if we cannot contact you.

Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

Relationship to child *

Agreement

Please read the following and tick if you agree

I will inform the Scout Group immediately of any change to the above information. I accept that the Scout Group will be keeping information about my child's membership of the Scout Movement for Scouting purposes. *

I agree

I give explicit consent to the holding of information of my child's health, disabilities, religion/faith, in accordance with the Data Protection Act 1998. No information held will be shared with third parties outside of Scouting without prior written consent. *

I agree

I give my permission for you to use any images/sound of my child for Scouting purposes only. This includes social media. *

I agree

I disagree