Membership Form

Thank you for your interest in joining Cherrybrook Scouts.

We invite prospective new members to attend for 6 weeks before committing to membership. For insurance purposes we do require that a membership application form ( also known as a Y1 form) be completed by all members and prospective members before their 1st visit.

Please fully complete the form below

If joining an open section, you will automatically receive a Youth Membership form by email.

Please check that the form is correct, print, sign and return a scanned copy

If joining a waiting list, you will receive the membership form once there is space in the section.

Section Membership Availability

Joey Scouts (ages 6-7) : Waiting List - For start in Term 2 2018 (April)
Billabong Cubs (ages 8-10) : Waiting List - For start in Term 2 2018 (April)
Callicoma Cubs  (ages 8-10) : Waiting List - For start in Term 2 2018 (April)
Scout Troop (ages 11-14) : Waiting List - For start in Term 2 2018 (April)

Each section meets weekly during school terms and also on occasional weekends for camp activities.

Joey Scout Mob (ages 6-7) : Tuesdays 6:00pm - 7:00pm
Billabong Cub Pack (ages 8-10) : Wednesdays 7:00pm- 8:30pm
Callicoma Cub Pack (ages 8-10) : Thursdays 7:00pm - 8:30pm
Scout Troop (ages 11-14) : Tuesdays 7:15pm - 9:00pm

Application for Youth Membership

* indicates required field

SECTION ONE : Member Details

Email address *
the email address of the primary carer
Youth Member Email Address
Full Given Names*
Surname*
Preferred First Name
Date Of Birth*
Sex
House Number and Street*
Town or Suburb*
State
Postcode*

Mobile Phone Number*
The primary carer mobile phone number used to contact parents about Scouting

Occupation
School*
Other School or Employer

Nationality

Country of Birth

Language spoken at home
If not English

Religion

Interests / Hobbies

Section applied for

Is the applicant the subject of any custody or access orders or agreements

Current or Previous Membership details of Scouts ( If Applicable)
Membership number (if known)

SECTION TWO : Family Details
Details of at least 1 Carer must be supplied

Primary Carer

Title
Additional Carer (Optional)

Title
Full Name
Full Name
Relationship to member
Relationship to member
Email Address
Email Address
Mobile Phone Number
Mobile Phone Number

SECTION THREE : Medical Details

Medicare Card Number*
Medical Fund Name and Number

Name of Ambulance Fund
Family Doctor Name*
Family Doctor Phone Number*

Are you allergic to any medications?


If yes - please detail

Do you suffer from Diabetes, Heart, Asthma, Epilepsy or other condition?



If yes - please detail

Do you suffer from any allergies?

If yes - please detail

Do you have any other conditions or disabilities that might limit full participation in activities?



If yes - please detail

Have you been immunised against tetanus


Approximate date

SECTION FOUR: Emergency Contact Details


Name of another person who can be contacted in an emergency*


Mobile Phone Number*