


To help your child’s leader please provide the following details
Contact Information
Child’s name Gender: M/F
Date of birth: Religion: Ethnicity:
Address
Post Code
Primary contact:
Tele: Email:
Partner contact:
Tele: Email:
Further Information
Can your child swim? Yes__ No__
Permission to use photos for Scouting publicity purposes Yes/ No
Medical Information Doctors Name
Surgery:
Address:
Tele No:
Please list any medical dietary/ allergies or special requirements your child has:
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