Enroll Your Child

Your Name*

First

Last

Your Address:*

Street Address Street Address Line 2 City Postal / Zip Code

Phone*

Your Email*

Child's Name*

First

Last

Child's Date of Birth*

day

/

month

/

year

Do you already have a sibling in the group?:*

Yes

No

Which section does your child wish to join?:*

Child's Gender:*

Female

Male

Self-identify

Prefer no to say

NB: The Squirrel section is parent led and you would be expected to undergo an enhanced DBS and help out on a parent rota.*

I agree to a help out and gain a DBS

My child is joining Beaver/Cubs/Scouts/YL's

Any special needs (physical, medical or educational), including Asperger’s, ADHD & Turrets:*

Any allergies (nuts, plasters etc.) or other medical condition that we need to be aware of:*

Any medication that may be required during a Scouting Activity (asthma inhaler, epi-pen etc.) *

If my child requires the above they know how to administer it:

Yes

No

Emergency Contact Name:*

First

Last

Emergency Contact Phone:*

Relationship to the member:*

We occasionally use the photographs we've taken, to use on our website or marketing leaflets. Please give permission to use photographs:*

Group Website

Marketing Leaflets

I do not give permission

If there's at least 1 adult in your household paying income tax, we can claim Gift Aid on the subs you pay. Please complete our declaration form on our website. May we claim Gift?*

Yes

No

Doctors Name:*

First

Last

Surgery Address:*

Street Address Street Address Line 2 City Postal / Zip Code

Doctor's Phone Number:*

NHS Number (if known):

Please confirm you're human:

2nd Bootle Scout Group

Copyright on Photographs

Organisation: