CHILD APPLICATION FORM FOR AL-HIJRAH SCOUTS Diversity information on members’ gender, ethnicity, religion or faith, and disability is requested by the Scouts to help in monitoring its membership. The data will help the Scouts to understand the makeup of the membership - monitoring progress against its inclusivity goals and prioritising development work both nationally and locally - and identify and help leaders meet any specific needs of individuals. Child Details Blank Forename Surname Age Date Of Birth Boy / Girl Boy / 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 If the child has any siblings already in Scouts, please give names and ages 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 take / use any medication (YES / NO)? If YES, please give details Does your child have any disability (YES / NO)? If YES, please give details Parent / Carer Details Blank Primary Parent / Carer Name Relationship to child Phone Email Address Full Address Emergency Phone Number If Different From Parent / Carer Phone Above Blank Al-Hijrah Scouts often make videos of activities to showcase our work and inspire others. Wherever possible, we actively avoid close-ups of children. 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 your child Photography / Video Consent Photography / Video Consent I am happy for photos, video and audio to be published of the young person in this form whilst undertaking Scouting activities across all channels Add any additional message / info Submit