Explorer Belt Kernow 2016
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About
Meet the Leaders
Application forms
Expedition Participation Under 18's
Expedition Participation Over 18's
Selection Weekend
FAQ's
Under 18's Expedition form
Under 18's - Please get your parent or guardian to complete this form!
Young Persons details
First Name/s
*
Please ensure this name is exactly as appears on your passport (including middle names) as should you be successful in being selected for the expedition, the details for booking flight tickets etc. ill be taken from here!
Surname
*
Please ensure this name is exactly as appears on your passport (including middle names) as should you be successful in being selected for the expedition, the details for booking flight tickets etc. ill be taken from here!
Date of Birth
*
Known as
*
If you have a nick name or a name other than which appears on your passport that you wish to be known by please let us know here.
Gender
*
Choose one
Male
Female
Young persons' email
*
Young persons Phone Number
*
Explorer Unit Details
Explorer Unit Name
*
Explorer Unit Leaders' Name
*
Passport Details
Passport Number
*
Passport Issue Date
*
Passport Country of Issue
*
Passport Expiry Date
*
Emergency Contact details
Emergency Contacts name
*
First
Last
Emergency Contacts' relationship young person
*
Emergency Contacts Address
*
Emergency Email Address
*
Emergency Mobile Number
*
Other Emergency Number
*
Emergency Contacts Home Phone Number
*
All the other important bits......
I can confidently swim 50m unaided
*
Yes
No
European Health Insurance Card Number (EHIC)
*
Blood Group (if Known)
*
Media Consent - During the training and the expedition we hope to take loads of photo and video images that we may Submit to newspapers, Scouts or other media on a local, county or national level for display and publicity purposes. Please indicate if you are happy for us to use images of your young person in this way.
*
Yes, I agree to images being used.
No, please don't use the images of my young person
Date of last Tetnus
*
Other Medical or requirements
*
Tell us about any other inoculations (including dates) you've had. Any other medication your on. Or any medical needs we should be aware of.
Anything else we need to know? (Allergies, dietary or religious)
*
Tell us about any dietary or religious requirements we need to know about. Along with any allergies or other anything else you think we may need to know? Things like phobias could be relevant! Anything you tell us here won't affect your chances of being selected for the expedition but will allow us to better prepare and tailor the expedition for everybody involved!
Are you taking part in the Cornwall County Scout Paintball Championships?
*
Yes
No
Declaration
As the parent/guardian of the individual named herein I confirm that I am wiling for Cornwall Scout Council to use the information provided for the purposes of managing the 2016 Explorer Belt. I understand that some information will be passed onto a small number of external partners, such as travel providers, who will only use the information provided to make bookings on behalf of the unit.
Parent/Guardians Name
*
First
Last
Relationship to Young Person
*
Date
*
Parent/guardians Email
*
Send