Membership Form This must be fully completed please. Section --- not set --- Leaders Beavers Cubs Scouts Members First Name Members Other Names Members Surname Members Date of Birth Members Address Members Postcode Members Contact Number Members Email address Primary Carer / Parent Full Name Add new Gift aid I am a UK taxpayer and i am happy for the group to claim gift aid on my donations I do not wish for the group to claim Gift aid on my donations Medical Issues Add new Has the young person been in contact with any infectious diseases within the last three weeks? Yes No Infectious diseases in past three weeks - Details? Does the young person have any allergies, additional needs behavioural needs or cultural needs that we need to be aware of? Yes No Cultural, allergies, behavioural needs Does the young person require any personal care to be provided? Yes No Personal Care Needs Does the young person require any medication? Please list. Yes No Medicines In the event of the young person needing simple medical treatment please tick which you give permission and consent for. I agree to leaders administering Paracetamol for fever or pain I agree to leaders aministering Ibuprofen for fever or pain I agree to leaders administering chlophenamine (piriton) or similar (antihistamines) for allergies such as hayfever. I give permission for a Doctor to dealwith wound cleaning and closure in the event of an accident I Give permission for a Doctor to use local anaesthetic in the event of an accident or emergency In the event of an emergency or an accident where treatment cannot be provided by the Doctor on site the young person will be transported with a leader to the local hospital for treatment. The parent and or guardian will be informed. Please tick to give general consentto any necessary medical treatments.