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Birkenhead Scouts

Providing #Skills for Life to the Communities of Birkenhead

How will you benefit from joining Scouting?

Scout Active Support allows you to contribute to the enjoyment of young people, without the need to make a regular commitment.


This Form

In order to add your details to our records, please complete the form below, which will be sent to one or more of our leaders.

Your Details

Contact Recipient:
* Title:
* Forename(s):
Known As:
* Surname:
Previous Surname:
 
 
* Gender:
* Date of Birth:
Honours:


 
 
Select
Or Other
* Nationality:
* Ethnicity:
* Faith/Religion:
 
 
* Address:
* Town:
County:
* Postcode:
 
 
Number
Type
Primary?
* Telephone 1:
* Telephone 1:
Type:
Primary?:
 
Telephone 2:
Telephone 2:
Type:
Primary?:
 
Telephone 3:
Telephone 3:
Type:
Primary?:
 
 
 
Number
Type
Primary?
* Email 1:
Email 1:
Type:
Primary?:
 
* Email 2:
Email 2:
Type:
Primary?:
 
* Email 3:
Email 3:
Type:
Primary?:
 
 
 
Type
Username
Social Media 1:
Social Media 2:
Social Media 3:
 
 
Scout Member No:
(If Known)
* Date Joined Scouting:
* Role Applied For:
Preferred Section:
Membership Type:

References

Referee 1 Name:
Relationship:
Address:
Postcode:
Email:
Telephone:

Referee 2 Name:
Relationship:
Address:
Postcode:
Email:
Telephone:

 
Receive Mail from Scout Assoc?
Recieve Mail from Scout Assoc Subsidiary?
 
 
Tick if you do NOT wish to receive details...
...about Scout Activity Centres
...of Events/Fundraising
...from Scout Shops Ltd
...regarding Scouting Insurance

Occupation:
Occupation Description:
Gift Aid?:
Qualification/Skills:
Hobbies/Interest:

Birkenhead Scouts
15 Balls Road, Birkenhead, Wirral, CH43 5RF
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