Blackwater Valley Young Leader Registration
Parents should complete this form in full to register their young person as a Young Leader with Blackwater Valley Explorer Scouts.
Name of Young Leader
Your answer
Which Section is the young person helping with?
Required
Which group(s) does the young person help with?
For example, 5th Farnborough
Your answer
Young Leader's Date of Birth
Your answer
Email address of Young Leader
Your answer
Parent/guardian email address
Your answer
Explorer Unit attended (if any)
Required
Young Leader's Home Phone Number
Your answer
Young Leader's mobile phone number
Your answer
Young Leader's Address
Your answer
Name of next of kin 1
(parent/guardian)
Your answer
Emergency contact number(s) for next of kin 1
Your answer
Name of next of kin 2 (if applicable)
(parent/guardian)
Your answer
Emergency contact number(s) for next of kin 2
Your answer
Doctors Name & Surgery
Your answer
Do you have any medical conditions or allergies, take any medication, have any additional needs or dietary requirements?
If so, please enter details here
Your answer
Young Leader's ethnicity
Your answer
Consent to attend
I confirm that I have parental responsibility for the participant. S/he is in good health and I agree to him/her being a Young Leader. I acknowledge the need for obedience and responsible behaviour on his/her part and that the Leaders reserve the right to send any Young Leader home. I give permission for the leaders to seek medical help in the event of any emergency. In the event I cannot be contacted, I give general consent to the treatment (including the use of anaesthetics) advised by the medical authorities and give my permission for a leader to sign any forms required. Note: the Medical Authorities can insist on parental authority before treatment commences.
Signed
Please type name of the parent/guardian completing this form.
Your answer
Submit
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