Membership Application Logo
  • 166th (Mickleover) Derby Scout Group

    Please use this form to Apply for Membership of any of the Sections in the Group. These details will only be used within the Scout Group and will NOT be passed to any other individual or organisation.
  • Young Person's Details

  •  - -
  • Parent or Carer's Details

  • Please Note, the 'Phone 1' number must be the number that we can contact you on whilst your child is in our care.

  •  - -
  • Gift Aid Declaration

  • The name of the Charity is - The Scout Association. The Charity Registration Number is - 306101

  • I declare that 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 Scout Group 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.

  • Photographs and Videos

    Images, still or video, of the young person named on this form will not be used in any way unless you give us your consent below: -

  • For further information on this issue please see the 'Photographs and Videos' section of our 'Privacy Policy' which can be found on the 'Contact Us' page of our website.

    I understand that if I change my mind, or we inadvertently publish material without parental permission, and it is brought to our attention by contacting the relevant Section Leaders, all images of the above named young person will be removed from all the Group's publications as soon as possible.

    The Group cannot be held responsible for any images taken by other parties. 

  • Reload
  • 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: