15th Glasgow (Eaglesham) Scout Group

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:______________________________________________

Doctor’s Contact Details

Current Medication, if any

Any special needs or requirements

Contact in last three weeks with infectious diseases

Activity in the year 2020

Subscription

Please tick





Gold DofE

£200.00

Gift aid


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