1st Blofield and Brundall Sea Scout Group

RN Recognised No 68

Login Form

Welcome to 1st Blofield and Brundall Sea Scout Group.

As a new member there is certain information that we are required to hold. Please download the form from here and return it to your section leader ASAP.

Alternatively, Please complete the form below 

Young Person's Information:

Title:*
Surname: *
Previous Surname:
Forenames:*
Date of Birth:*
Known As, if different from Christian Name:
Nationality:*
Gender:*
Ethnicity:*
Religion:*
School/College:
Address:*
Email Address:*
Home Phone No:*
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Emergency Contact Details:

Name:*
Known As, if different:
Relationship:*
Primary Phone No:*
-
Secondary No:
-

Young Persons Medical Details:

Doctor/Surgery:*
Surgery Address:*
Surgery Address 2:*
Surgery Post Code:*
Phone:*
-
NHS Number:
Dietary Needs:
Medical Information:
Additional Needs/Disability:

Contact 1 (Designated Primary Contact - Not EMERGENCY Contact).

Primary Contact Title:*
Primary Contact Name:*
Primary Contact Known As, if different from above:
Primary Contact Gender:*
Primary Contact Address:*
Primary Contact Village: *
Primary Contact Post Code:*
Primary Contact Telephone No:*
-
Primary Contact Mobile Phone:*
-
Primary Contact Email Address:*
Contact 1 Gift Aid: (By selecting yes, you are consenting to us claiming Gift Aid on your behalf. You must pay an amount of income or capital gains tax at least equal to the tax we reclaim on the payments. You can cancel this declaration at any time by notifying us. Please notify us if you change your name and address or cease to pay income tax):*

Contact 2 Details:

Contact 2 Title:*
Contact 2 Name:*
Contact 2 Gender:*
Contact 2 Known As, if different from above:
Contact 2 Address:*
Contact 2 Village:*
Contact 2 Post Code:*
Contact 2 Telephone No:*
-
Contact 2 Mobile Phone No:*
-
Contact 2 Email:*
Contact 2 Gift Aid: (By selecting yes, you are consenting to us claiming Gift Aid on your behalf. You must pay an amount of income or capital gains tax at least equal to the tax we reclaim on the payments. You can cancel this declaration at any time by notifying us. Please notify us if you change your name and address or cease to pay income tax)(2):*
Any Other Relevant Information: