BECOME A SCOUTS LEADER

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.

Leader Details

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Forename

Surname

Age

Date Of Birth

Brother / Sister Brother / SisterBrotherSister

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

Do you have any health problems (YES / NO)? If YES, please give details

Do you have any allergies (YES / NO)? If YES, please give details

Do you take / use any medication (YES / NO)? If YES, please give details

Do you have any disability (YES / NO)? If YES, please give details

Phone1

Phone2 (optional)

Email Address

Full Address

Emergency Contact Name

Relationship

Emergency Phone Number If Different From Parent / Carer Phone Above

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Occupation

Do you have any experience of Scouts or other youth work (YES / NO)? If YES, please give details

Do you have any children that you would like to register for Scouts (YES / NO)? If YES, please give names and ages

Al-Hijrah Scouts often make videos of activities to showcase our work and inspire others. Wherever possible, we actively avoid close-ups. 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 you.

Photography / Video Consent Photography / Video Consent I am happy for photos, video and audio to be published of the young person named in this form whilst undertaking Scouting activities across all channels

Any place given to your child as a "Leader's Child" is dependent on you fulfilling the minimal requirements of being a leader and your child will lose their place if the requirements are not fulfilled

Leader Consent Leader Consent I understand that any place given to my child as a "Leader's Child" is dependent on me fulfilling the minimal requirements of being a leader and my child will lose their place if the requirements are not fulfilled

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