Lonsdale District Explorer Scouts... member registration A copy of this form should be sent to : Tracy Seton (DESA) 21 Broadlands Drive, Bolton-Le-Sands, LA5 8BH It should include a cheque for £12 made payable to Lonsdale District Scout Council. This joining fee covers a Knecker, Badges and Nametape. Full Name: Personal Information Known As: Address: Postcode:D.O.B:Gender: Home Phone:Mobile: Under the Data Protection Act 1998 the data contained in this section is classed as 'sensitive personal data'.. By providing the data and signing this form you will give your explicit consent for this data to be held. Religion:Ethnicity: Next of Kin Full Name: Address: Relationship: Postcode: Home Phone:Work Phone:Mobile: Doctor Information Name:Address: Postcode: Phone: Photograph Consent Photos and video images of Explorers taking part in Scouting activities may be used in Scouting newsletters and displays or included on Scouting websites. Please indicate whether you are happy for images of your child to be used in his way. YesNo Scouting Former Scout Group: Young Leaders to complete only: Scout Group: Section: 1 of 2 Explorer Scout Unit:

2 of 2 Medical Information Under the Data Protection Act 1998 the data contained in this section is classed as 'sensitive personal data'.. By providing the data and signing this form you will give your explicit consent for this data to be held. NHS Number:Date of Last Tetnus: In the Spaces below please give details of the following: Dietary Needs (Including both elective and medical (Vegetarian, Nut Allergy etc): Special Needs ( disabilities and issues the leaders need to be aware of (ADHD, Dyslexia, Dyspraxia etc): Medical Requirements: any medicines, diets or treatments currently being taken or followed including, if appropriate dosage details and the specialist and hospital concerned. Include any self administered treatments and also non prescription preparations such as herbal medicines. Please also note any known allergies to medicines (e.g. penicillin). Gift Aid Consent I want Lonsdale District Explorer Scouts to treat all payments I have made since 1st April 2008, and all payments I make from the date of this declaration in respect of my child’s membership subscription for the Explorer Scout Units as Gift Aid Donations until I notify you otherwise. 1. You must pay an amount of income tax or capital gains tax at least equal to the tax we reclaim on your payments (currently 28 pence for every £1 you give). 2. You can cancel this declaration at any time by notifying the Explorer Scout Unit. 3. Please notify the Unit if you change your name, address or tax situation. Tick to Gift Aid: Consent I consent to the information provided on this form being held by Lonsdale District Scouts in paper and electronic formats. I consent to its use in connection with organisation and membership of the Scout Association and to it being shared, when necessary, within the Scout Association. I give explicit consent to the holding of the ‘Sensitive’ Information indicated throughout this form and understand that this information is required by leaders to enable participation in Scouting activities. Signed: Print Name: Relation to Young Person: Date: