First Name

Surname

Date of Birth (dd-mm-yyyy)

Boy or Girl Boy or GirlBoyGirl

Nationality

Religion ReligionBuddhistChristianHinduJewishMuslimSikhAny Other Religion/FaithNo ReligionPrefer not to say

Ethnicity EthnicityASIAN – PakistaniASIAN – BangladeshiASIAN – IndianASIAN – OtherBLACK – AfricanBLACK – CaribbeanBLACK – OtherMIDDLE EASTERN – ArabMIDDLE EASTERN – OtherMIXED – White and Black CaribbeanMIXED – White and Black AfricanMIXED – White and AsianMIXED – OtherWHITE – English / Welsh / Scottish / Northern Irish / BritishWHITE – IrishWHITE – Gypsy or Irish TravellerWHITE – OtherOTHERPREFER NOT TO SAY

Does your child have any siblings already in BCM Scouts, If Yes, Please fill in their name(s) and age(s)

Does your child have any Health Problems (Yes/No?). If Yes, Please Give Details:

Does your child have any Allergies (Yes/No?). If Yes, Please Give Details:

Does your child have to take / use any medication (Yes/No?). If Yes, Please Give Details:

Does your child have any disabilities (Yes/No?). If Yes, Please Give Details:

Parent / Carer Details

Primary Parent / Carer Full Name

Relationship to Child

Phone number of Parent / Carer

Email Address

Full Address, including Postcode

Name of Emergency Contact (if different from above)

Relationship of Emergency Contact to Child

Phone No of Emergency Contact

Birmingham Central Mosque Scouts often make videos of activities to showcase our work and inspire others. Wherever possible, we actively avoid close-ups. At the moment we are unable to blur individual faces, so if you would prefer to avoid such photos / videos then we will not be able to accommodate you. Birmingham Central Mosque Scouts often make videos of activities to showcase our work and inspire others. Wherever possible, we actively avoid close-ups. At the moment we are unable to blur individual faces, so if you would prefer to avoid such photos / videos then we will not be able to accommodate you. I am happy for photos, video and audio to be published of the young person named in this form whilst undertaking Scouting activities across all channels

First Name

Surname

Date of Birth (dd-mm-yyyy)

Mobile Number

Email Address

Full Address, including Postcode

Brother or Sister Brother or SisterBrotherSister

Ethnicity EthnicityASIAN – PakistaniASIAN – BangladeshiASIAN – IndianASIAN – OtherBLACK – AfricanBLACK – CaribbeanBLACK – OtherMIDDLE EASTERN – ArabMIDDLE EASTERN – OtherMIXED – White and Black CaribbeanMIXED – White and Black AfricanMIXED – White and AsianMIXED – OtherWHITE – English / Welsh / Scottish / Northern Irish / BritishWHITE – IrishWHITE – Gypsy or Irish TravellerWHITE – OtherOTHERPREFER NOT TO SAY

Nationality

Religion ReligionBuddhistChristianHinduJewishMuslimSikhAny Other Religion/FaithNo ReligionPrefer not to say

Do you have any Health Problems (Yes/No?). If Yes, Please Give Details:

Do you have any Allergies (Yes/No?). If Yes, Please Give Details:

Do you have take / use any medication (Yes/No?). If Yes, Please Give Details:

Do you any disabilities (Yes/No?). If Yes, Please Give Details:

Occupation

Do you have any experience of youth Work (Yes/No?). If No, Please type in N/A, If Yes, Please Give Details:

Do you have any children that you would like to register (Yes/No?). If No, Please type in N/A, If Yes, Please Give Details, full name and age:

Emergency Contact Name

Relation to Emergency Contact

Emergency Contact Persons Phone Number

Birmingham Central Mosque Scouts often make videos of activities to showcase our work and inspire others. Wherever possible, we actively avoid close-ups. At the moment we are unable to blur individual faces, so if you would prefer to avoid such photos / videos then we will not be able to accommodate you. Birmingham Central Mosque Scouts often make videos of activities to showcase our work and inspire others. Wherever possible, we actively avoid close-ups. At the moment we are unable to blur individual faces, so if you would prefer to avoid such photos / videos then we will not be able to accommodate you. I am happy for photos, video and audio to be published of the young person named in this form whilst undertaking Scouting activities across all channels

Leader Constent: Any place given to your child as a "Leader’s Child" is dependent on you fulfilling the minimal requirements of being a leader and your child will lose their place if the requirements are not fulfilled. Leader Constent: Any place given to your child as a "Leader’s Child" is dependent on you fulfilling the minimal requirements of being a leader and your child will lose their place if the requirements are not fulfilled. I understand that any place given to my child as a "Leader's Child" is dependent on me fulfilling the minimal requirements of being a leader and my child will lose their place if the requirements are not fulfilled