Membership Application

166th (Mickleover) Derby Scout Group

Please use this form to Enquire about, or to Apply for, Membership of any of the 3 Sections in the Group. These details will only be used within the Scout Group and will NOT be passed to any other organisation.
Section *

Beavers Cubs Scouts
Child's Details
First Name *
Last Name *
Date of Birth *

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Any Medical Conditions that we need to be aware of? *
Address Line 1 *
Address Line 2
City *
Post Code *
Parent / Guardian's Details
Title *
First Name(s) *
Last Name *
Phone 1
Phone 2
Phone 3
Your email address *
Date *

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Gift Aid Declaration
I want to Gift Aid any donations I make in the future or have made in the past 4 years to: *

Yes No
The name of the Charity is - 166th (Derby North) Scout Group
The Charity Registration Number is - 306101
I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.
Please notify the charity if you:

● want to cancel this declaration

● change your name or home address

● no longer pay sufficient tax on your income and/or capital gains

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.
Prove that you are not a machine by Enter the text as shown *
By clicking on the Submit button you are not committing yourself to anything. The information that you have entered will only be used by the Scout Group (and only by the Scout Group) if / when your child starts attending the appropriate Section of the Group.
Should be Empty:

166th (Mickleover) Derby Scout Group