GREATER MANCHESTER EAST SCOUTS

D of E REGISTRATION FORM 2016

Name: / M/F / DOB: / Age
Address:
Post Code:
Phone Number: / Mobile:
e-mail:
Unit: XBU 1st Bramahall / District: Ladybrook Valley
Meeting Night and Time: Thu 19:45-20:00 / Address of meeting place:
The Bramley Centre, Bramhall
Post Code:SK7 1DY
Leader Name:
Paul Winterburn / Leader Address:
10, Canberra Road, Bramhall
Post Code: SK7 1LG
Leader phone number:
0161 439 0173 / Leader mobile number:
07712 464285
Leader e-mail address:
Bronze/Platinum / Silver/Diamond / Gold/QSA
Tick Awards completed
Tick pack required
Cost / £19.00 / £19.00 / £26.00
We will register you for QSA.
Name of next of kin: / Relationship to next of kin:
Next of kin e-mail address: / Next of kin phone number:
Ethnicity – please tick one box
Asian or Asian British / Black or Black British / Chinese or Other
Indian / Pakistani / Bangladeshi / Other / Caribbean / African / Other / Chinese / Other
Gypsy and Traveller / Mixed / White
Irish Traveller / Gypsy / Roma / Other / White & Black Caribbean / White & Black African / White and Asian / Mixed
Other
Other (please specify) Do not wish to state:
The following information is used to assist us to meet the needs of all young people. Please complete this section if you need to answer “yes” to either question.
Do you consider yourself to have a disability as defined by the DDA as a “physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities”? / YES/NO
Do you consider yourself to have any medical needs which you believe may influence you on certain activities (ie: the Expedition section)? This information is only used to ensure your safety on DofE activities. / YES/NO
If you have answered “yes” to either of the above please specify
Please return form and cash or cheque(payable to “GMECSC”) to:
Bernard or Sheila O’Flaherty: 7 Windsor Grove, Ashton-under-Lyne, Lancashire. OL6 8UU
Phone: 0161 330 9641 orBernard 0776 567 6032or Sheila 0780 308 4422.
e-mail: or

Data supplied on this form and information about DofE activities recorded in eDofE will be used by the DofE charity, the Scout Association and GME Scouts to monitor and manage DofE participation and progress.

All contact from the DofE charity using personal data will communicate useful and relevant information to help participants complete a DofE programme, to help the Scout Association and GME to run DofE programmes more effectively or to help the DofE Charity improve the quality and breadth of its programmes. All contact will be via the eDofE messaging system.

You will receive a welcome email from edofe with your username and password. Please log-in and enter your details and add what you are going to do in the various sections. You will need to keep it up to date in order to have it approved at the end.