E-mail: info@scouting.org.za Website: www.scouting.org.za Tel: 0860 SCOUTS (726887)
2013/v1
Application for Youth Membership
(This form is to be completed by all new members.
A copy must be retained by all new members and original forwarded to the Regional Headquarters for registration.)
Province: District:
Group: Branch: Cub (7-10) Scout (11-17)
I, (full names) , parent/legal guardian of (minor
child’s full name) , hereinafter referred
to as ‘ward’, shall be glad if you accept this application for my ward to be admitted as a member of your Group.
I understand that the Cub/Scout programme is an active one, which includes opportunities for adventure, service and
fun. I undertake to provide my ward with the required uniform, see that he/she attends meetings regularly and pays
his/her membership contributions.
I am aware of the Child Protection Policy of SCOUTS South Africa, which aims to safeguard the welfare of all members
by protecting them from physical, sexual and emotional harm.
I am aware that SCOUTS South Africa accepts no responsibility for any loss, injury or damage that the person or
property of my ward may sustain whilst engaged in any Scouting activity and I waive any right that I or my ward may
have to claim compensation against SCOUTS South Africa or other members in respect of any loss, injury or damage
incurred whilst engaged in any Scouting activity howsoever arising and whether as a result of negligence or otherwise
and I indemnify them against all such claims.
I agree and authorize that photo’s, statements, audio visual recordings, video and sound bites taken, recorded and
collected from my Ward during activities with SCOUTS South Africa may be used free of charge and at the discretion
of SCOUTS South Africa as part of their marketing, communication and fundraising campaigns.
Signed _____________________________ Date
Father/Mother/Legal Guardian Day Month Year
Personal Details of Recruit
Surname Initials
First Names
ID Number Date of Birth
Day Month Year
Address
Code
Telephone Home or/and Cell
Email Address Sex
Religious denomination
Special Conditions (
State any handicap, disability, special health conditions, not permitted activity, etc)
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OFFICIAL USE
Date captured on database:
_____________________
No:
________________
Signed: ________________
Male
Female
E-mail: info@scouting.org.za Website: www.scouting.org.za Tel: 0860 SCOUTS (726887)
2013/v1
Name Doctor
Doctors Telephone
Medical Aid Scheme
Medical Aid Number
Medical Aid Principal Member
Personal Details of Parent/Legal Guardian
Parent 1:
Surname Initials
First Names
ID Number Date of Birth
Day Month Year
Postal Address
Code
Telephone Work or/and Cell
Email Address Sex
Marital Status
Occupation
Employer
Parent 2:
Surname Initials
First Names
ID Number Date of Birth
Day Month Year
Postal Address
Code
Telephone Work or/and Cell
Email Address Sex
Marital Status
Occupation
Employer
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Male
Female
Male
Female