CUSAGC Membership Form - New Members
Please fill in all fields marked with an asterisk - we are obliged to hold this information by SSAGO and The Scout Association.
Our records are stored securely, and only the committee have access to them.
The information in the first section will be kept for as long as you are a member of the Club, or are signed up to an email list, and it is your responsibility to inform us if it changes.
First Name *
Surname *
Email *
Date of Birth? *
DD/MM/YYYY Please
Email List *
Members - All emails; Dismem - Weekly emails and key events only; Interested - Local leaders and potential leaders - little club information. You can sign up to multiple lists.
Required
UG/PG/Grad/Other *
College/University *
Graduates too please, please put N/A if not applicable
Matriculation Year *
The year you started your course. Please put N/A if not applicable.
Course
Home Phone
Mobile Phone *
Please provide at least one phone number, preferably a mobile
Term Address
If not a college
Other Address
Do you have a current SSAGO/Scout (not Guiding) CRB/DS/ANI? *
IF YES: also check 'other' and supply any details (date issued and disclosure number if possible please)
Required
Dou you have a current first aid certificate or activity qualification?
Please specify
Are you currently a Leader, Occasional Helper or Section Assistant?
Or other approved role
Are you already involved with a group(s)?
Including Network or Senior Section. Please also check 'other' and specify if yes.
Are you interested in finding a group?
Check all that apply
Anything else you'd like to tell us?
InTouch Information
The information below will only be acted on in an emergency and at any other time that you request. Please fill in as much as possible - if you wish to keep a medical condition private we cannot compel you to tell us, but it could be important in an emergency situation. Equally, it is in your interest to let us know your dietary requirements!
Please contact the club chair (chair (at) cusagc.org.uk) if you have any concerns or questions. This information will be kept for as long as you are a member of the Club, and it is your responsibility to inform us if it changes. If you wish us to remain holding this data for as long as you are active with the Club (e.g. for Service Events) to save repeated filling-out of paperwork, please let us know.
Primary emergency contact's name *
Primary emergency contact's relationship to you
Primary emergency contact's phone number *
Primary emergency contact's alternative phone number
Primary emergency contact's address *
Alternative emergency contact's name
Alternative emergency contact's relationship to you
Alternative emergency contact's phone number
Alternative emergency contact's alternative phone number
Alternative emergency contact's address
Doctor's name
If you do not yet have a Cambridge doctor assigned, please put "pending".
Doctor's Surgery Phone
Doctor's Surgery Address
Date of last tetanus vaccination
Dietary Requirements
Allergies
This is not compulsory but may help us/those treating you in an emergency situation.
Medical conditions
This is not compulsory but may help us/those treating you in an emergency situation.
Current medication taken
This is not compulsory but may help us/those treating you in an emergency situation.
Any other health information
Terms of membership
Please read and confirm *
I understand that I must inform the CUSAGC secretary if any of these details should change while I am a member of the club. By becoming a member, I am consenting to CUSAGC (i) Retaining my information in the club's secure online database, which only the committee can access, (ii) Passing on my details to SSAGO (the Student Scout and Guide Organisation), The Scout Association or Girlguiding for insurance purposes, (iii) Adding me to CUSAGC's mailing list (I can unsubscribe, or change to a lower volume list, at any time). I understand that I will have to pay my membership fee (£16) promptly after completing this form, which will entitle me to membership until the start of next academic year. I understand that I must be in full-time further or higher education to join the club, except under special circumstances.
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy