Phoenix Explorer Scout Unit (Potters Bar) Joining Form
FOR COMPLETION BY PARENT(S)/GUARDIAN

Membership Application Form. This is a confidential personal record which will be held in accordance Data Protection Legislation. Although parts of this form have been set to 'voluntary' please supply all information that you can.

We require a standing order to be completed in order to collect subs payments of £8 a month. Please see our website, phoenixexplorers.org to download the form.

If your child would like to complete the Duke of Edinburgh Bronze award, you will need to download and complete the form here, following the instructions on the form: https://www.hertfordshirescouts.org.uk/wp-content/uploads/Enrolment-form-Jan2018.pdf


Privacy Notice
Purpose of Collection: The information you provide in this form is being collected with a view to safeguarding the welfare of the young person concerned during their membership of (and attendance at activities organised by) the Phoenix Explorer Scout Unit and for general administration of the Unit. In the event of a young person requiring emergency treatment, the medical information provided within this form will be of assistance to medical authorities in deciding which is the most appropriate treatment to give.

Consent: By providing this information, you hereby give the Potters Bar & District Scout Council (and any individuals that may necessarily require this information; including medical professionals) permission to lawfully process this data in accordance with the above-stated purpose.

The information collected in this form will be kept confidential save where it becomes necessary to disclose said information to ensure the welfare of the young person concerned. Information provided will be deleted six months after leaving the Unit. You can withdraw your consent at any time by contacting james.sanderson@pbscouts.org.uk. A statement of your data privacy rights can be found on the Information Commissioner's Office website, www.ico.org.uk.

Do you agree to give the consent as detailed in the above Privacy Notice? *
Personal Details, Parents & Emergency Contacts
Child's Surname *
Your answer
Forenames *
Your answer
Date of Birth *
In the format 22/may/1996
Your answer
Address *
Your answer
Child's mobile number. *
This is required for sending out details of events each week. Alternatively, you can provide an Adult's mobile number.
Your answer
Religion *
This is required for the Annual Scout Census
Your answer
Name of School
Your answer
Mother's Full Name
Your answer
Mother's Address, Telephone & Mobile number and E-mail.
Please list below.
Your answer
Father's Full Name
Your answer
Father's Address, Telephone & Mobile number and E-mail.
(If different to Mother's)
Your answer
If parents are divorced or separated are there any family circumstances of which you would like us to be aware.
Please let us know if any person has Parental Responsibility, as defined by the 'Children's Act 1989'
List their name, address, telephone numbers and E-mail.
Your answer
Emergency Contact: Please also supply us with the name and number of another person we could contact in an emergency. *
Your answer
Medical
NHS Number
Your answer
Does your child take any regular medication? *
Required
If yes, which medication and how often?
Your answer
Does your child carry the medication with them at all times?
Does your child have any allergies? *
Medication/Food etc.
Required
If yes, please give full details below.
Your answer
Is your child protected against Tetanus? *
Required
When was their last injection? *
Your answer
Please list any dietary needs.
Your answer
Sun Exposure *
We must ask that you be particularly aware that some Scouting activities take place out of doors when your child may be at risk of prolonged over-exposure to the sun and it is important that your child is protected so as to avoid the risks of skin cancer in later life. As a parent we ask you to ensure that your child knows the importance of being in the shade when possible and wearing a hat, together with appropriate clothing. Please apply sun screen to exposed areas of skin before children come to scouting activities where they may be at risk and ensure that they are provided with sun screen for further application, and for camps where they will be required to apply sun screen themselves.
Required
Does your child have a disability that we should be aware of? *
Required
If yes, please provide full details of the disability.
Please feel free to speak with us in addition to this disclosure.
Your answer
Please provide contact details for your Child's doctor. *
Name, Address, Telephone no. of surgery.
Your answer
Please provide any further medical information you feel may be important.
Your answer
Important Notice
Note: The medical profession takes the view that the parent’s consent to medical treatment cannot be delegated. This view is explicit in the Children’s Act 1989. Thus medical consent forms have no legal status and a doctor/nurse insisting on the consent of a parent to a particular treatment has the right to do so. For this reason, we cannot insist that parents/guardians agree to the below medical authority. However, it can be a comfort to medical staff to have general consent in advance from parents or to have a Scout Leader on hand able to sign forms required by medical authorities.
Consents
Please read this section carefully and give your consent, or otherwise, where required. This section must be completed by Parent(s)/Guardian.
Parental/Guardian's Consent
In the event of a situation where a doctor or hospital advises treatment for your child, you will be contacted. However, if a leader is unable to make contact with a child's parents or guardian, we will need your consent to act as medically advised. We must therefore ask parents/guardian to give their consent below for a leader to take responsibility for the child at the time of the incident to act in the best interests of the child. There will also be times when events/activities might take place outside the normal meeting places of the Unit but within an approximate 10 mile radius of Furzefield. You will normally be advised of such an activity by the programme. You are however, asked to indicate below your authority for us to take your child out either with a leader or Parent Helper. Activities further afield are generally subject to other consent/application forms.
Medical Authority *
In the event that my/our child requires medical assistance and the parents/guardians cannot be contacted, I/We authorise the Leader responsible for my/our child at the time of the incident to act on my/our behalf as medically advised.
Required
Consent for Activities Outside of Normal Meeting Places. *
I/We have no objection to my child participating in local activities away from the main meeting places.
Required
Photography *
I/We have no objections to my/our child's photograph being taken as a record of an activity or for general publicity of the unit's activities.
Required
Validity *
These consents will remain valid throughout the duration of membership unless new written instructions are received by the Explorer Scout Leader.
Required
Declaration *
Please type your name below along with the date to indicate your agreement to the above consents for which you have selected 'Agree.'
Your answer
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