Permission form
Eastwood Explorers Duke of Edinburgh subscription form
Name of Young Person: _________________________________ DOB: ______________
Address: ________________________________________post code__________________
Emergency Contact Name: ___________________________________________________
Mobile Phone Number:_______________________________________________________
House Phone Number:_______________________________________________________
Email address: _____________________________________________________________
Explorers Mobile Phone Number:______________________________________________
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Doctor’s Contact Details |
Current Medication, if any |
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Any special needs or requirements |
Contact in last three weeks with infectious diseases |
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Activity in the year 2020 |
Subscription |
Please tick |
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Gold DofE |
£200.00 |
Gift aid
