Young Leaders Module A Registration Form
Tuesday 19th February. Finnart Street HQ.
What unit do you belong to?
Date of Birth
What Scout Group do you help with?
85th (Wemyss Bay)
No Group at present
What section do you work in?
Dont have a placement
Mobile or House phone no.
Emergency Contact Name
For during the Event
Contacts Relation to Young Person
The Contacts Address
Contacts Home Phone Number
We need at least one of these numbers
Contacts Mobile Number
Please provide any medical or further information that we should be informed of.
Emergency Medical Treatment
By ticking this box you agree that If it becomes necessary for my son/daughter to receive medical treatment and I cannot be contacted by telephone or any other means to authorise this, I hereby give my general consent to any necessary medical treatment and authorise the Leader (or in their absence one of the assistant leaders), to sign any document required by the hospital authorities
Please tick box
Sometimes photos and video images of Explorer Scouts taking part in activities are submitted to local newspapers, the Unit, District or National newsletters and websites or put on display for publicity purposes. Please agree or disagree below for images to be used for this purpose.
By ticking the following box i as a parent / consenting guardian am signing and agreeing to this document.
agree ( e - signature)
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