Registration Form
Fill out the form carefully for registration. Please double check email addresses.
Explorer Scout Name
First Name
Last Name
Date of Birth
Please select a day
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Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2010
2009
2008
2007
2006
2005
Year
Address
Street Address
Street Address Line 2
City
Postal / Zip Code
Explorer Scout Contact E-mail
All details will be sent to this email address. Please check it carefully.
Parent Contact E-mail
All details will be sent to this email address. Please check it carefully.
Name of Emergency Contact
First Name
Last Name
Relationship to Explorer Scout
Mobile Number for Emergency Contact
Please detail any medical (including medication) or dietary requirements (including allergies) we should be aware of for this camp.
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What is your Scout District?
Please Select
Avonvale
Bromsgrove
Redditch
South Marches
Wyre Forest
Ross
The Malverns
The Shire
Worcester
Please state the name of your Explorer Unit
If you need to inform the leaders of any pastoral , photo or social media requests, please detail here:
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Submit
Please ensure the box is ticked
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Explorer Scout Social Camp
£
75.00
Quantity
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Item subtotal:
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0.00
Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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