6th Barnsley (Goldthorpe) Application Form
If you have any difficulty in completing the form, please email Mark@Goldthorpescouts.org.uk
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First Name *
Young Person's First Name
Last Name *
Family Name, young Person's Surname
Date of birth *
Young Person's DOB
MM
/
DD
/
YYYY
Primary Contact's First Name *
e.g. Mary
Primary Contact's Last Name *
e.g. Jones
Primary Contact's Date of birth *
Primary Contact's DOB
MM
/
DD
/
YYYY
Address 1: Number + Street *
e.g. 12 Lockwood Road
Address 2: Village *
e.g. Goldthorpe
Address 3: Town / City *
e.g. Barnsley
Address 4: County *
e.g. South Yorkshire
Post Code *
e.g. S63 9LX
Primary Contact's Email *
Primary Contact's Home Phone
e.g. 01709 766123
Primary Contact's Mobile *
e.g. 07123 456789
What is your full name and what is your relationship to the young person you are applying on behalf of? *
State your name and relationship to the young person you are applying on behalf of. All information given on this form will be used in accordance with the Data Protection Act 1998. Information given will only be used in connection with your young person's membership of the Scout Movement in the United Kingdom.
Primary Contact’s Occupation *
e.g. Carer
Secondary Contact’s First Name *
e.g. Tony
Secondary Contact's Last Name *
e.g. Smith
Secondary Contact’s Occupation *
e.g. Joiner
Photo's Allowed *
Do you consent for images/photographs of the young person to be used in the publicity and promotion of Scouting?
Section *
Which section would the young person like to join? Select from one of sections currently available that matches young person's age.
Swim *
Young Person's swimming distance (meters) - State whether the young person can swim, and if so, what distance in meters?
SEN Notes *
Does the young person have any special educational needs, learning difficulties or has a statement of special needs? State any known educational issues or learning difficulties or NONE
Raise Funds *
When we are able to offer your young person a place, can you support the Scout Group to raise additional funds? As we periodically need to organise fundraising events as not all the Group's expenses can be met from subscriptions
Diet Notes *
Details of any special dietary requirements. State any special dietary requirements of the young person or NONE
Medical Notes *
Does the young person have any special medical needs, long standing health issues including known allergies? State any known health issues or allergies or NONE
School *
Select the school attended by the young person
Gift Aid *
Are you a UK Taxpayer? Since our Scout Group is a charity, we may be entitled to claim Gift Aid on all your payments, which means the Inland Revenue contributes an additional 25% on top of your payment at no extra cost to you. Please read the following carefully and indicate your response by answering the question: I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs), that I donate to, will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on every £1 that I give.
Name of GP (Doctor) *
Name of the young person's GP
GP (Doctor) Phone Number *
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