Your son/daughter/ward will be attending Cabot District Explorer Scouts and is eligible to attend any of the Explorer groups meeting in the district. Subs are £35 payable at the start of each seasonal term to Cabot District Scout Council.

Please make every effort to see the district programme of activities which is issued to Explorers at the beginning of each term. This form is required to indicate your consent to the activities as published. If there are any particular activities that you do not wish you son/daughter/ward to attend please contact the Unit Leader. Adventurous activities or activities not contained in the programme will be the subject of separate consent forms. Please answer the following questions as fully as possible. In the event of your child requiring emergency treatment, it will help the medical authorities in deciding which is the most appropriate treatment to give.

Explorer Scout’s Details (Please complete in BLOCK CAPITALS)

Forenames & Surname / Date of Birth
Address
Postcode Home Telephone Number
E-mail Address to be used for emailing activity information / Mobile Number to be used for text messaging for Explorers
Details of any known medical condition which might cause difficulties with activities or may require prompt treatment. / Date of last Tetanus injection (Enter NK if not known)

Mothers Details Fathers Details

Name
Mobile Number
Employment
Skills/interests
I can help by doing
Personal Scouting experience
Address & phone if different from above / Name
Mobile Number
Employment
Skills/interests
I can help by doing
Personal Scouting experience
Address & phone if different from above
Name & Address of a relative in case of emergency, not same contact details as in previous box.
......
......
......
Home Telephone:
......
Mobile Telephone:
...... / Family Doctor’s Name and Address
Dr Name: ......
Surgery Name & Address......
......
......
Postcode: ......
Telephone:......

Please circle the Unit which the Explorer will be attending:

Unit

BRABAZON
(1st Bishopston) / BROCKMEAD
(4th Southmead) / SPANIORUM
(26th W-O-T) / STEAMA
(167th W-O-T) / KARIBU
(56thLawrence Weston) / BRENTRY
(169th Brentry)

If A YOUNG LEADER, Please indicate which group and section you assist with:

Young Leaders

GROUP : / SECTION :

Consent Declaration:

I give my permission for the Explorer Scout named above to attend the activities published in the termly programmes and for photos to be taken and used for displays etc.

If it becomes necessary for my child 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 Warranted Explorer Scout Leader to sign any document required by the hospital authorities.

I will inform the Warranted Explorer Scout Leader if any of the information given on this form changes at any time during the academic year.

Gift Aid Declaration

I wish Cabot District Scout Council to treat all donations I make from the date of this declaration until further notice as Gift Aid donations. (I pay income tax at least equal to the tax claimed from the subs payments)
Name of Parent/Carer / Relationship to Young Person
Signature / Date

Please return this completed form to your Unit leader.