1. THE SCOUT ASSOCIATION OF AUSTRALIA
SCOUTS WA
APPLICATION FOR YOUTH MEMBERSHIP
M1
Page 1 of 2
Form M1 - September 2011
Form to be used only if proposed Member is under 18 years of age
Particulars of Applicant
FAMILY NAME Preferred Name
Given Name Middle Name(s)
Date of Birth (DD/MM/YYYY) Gender: Male
Female
Home Address
Town / Suburb Post Code
Postal Address
Spiritual Belief
Home Phone
Mobile Phone
Particulars of Parent(s) / Guardian(s)
Mother / Guardian
FAMILY NAME
Given Name
Home Address(if different to applicant)
Suburb & Post Code
Home Phone
Work Phone
Mobile Phone
Email Address
Father / Guardian
Are there any custody / guardianship issues relating to the child?
If yes, please provide details on a separate sheet.
to be entered by the Group or Section Leader
Membership Number
Yes No
Scout Group Details
Group District
VENTURER UNIT ROVER CREW
Date Joined Date Invested Birth Certificate sighted by
Please indicate which Joey Mob, Cub Pack or Scout Troop in box if more than one If over 18, use M3 Form
SCOUT TROOPCUB PACKJOEY MOB
Occupation
Relationship to child
Email Address
Name of SchoolCountry of Birth
Tick if you are of Aboriginal or Torres Strait Islander OriginTick if you come from a Non-English speaking background
Work Phone
(if relevant)
(if relevant)
Has the applicant been assessed by a School or Medical Practitioner as having a special need?
This information is requested so that appropriate adult resources or building facilities can be provided.

2. THE SCOUT ASSOCIATION OF AUSTRALIA
SCOUTS WA
APPLICATION FOR YOUTH MEMBERSHIP
M1
Page 2 of 2
Form M1 - September 2011
Indemnity
If the applicant is accepted as a member of Scouts WA, I agree to and do hereby indemnify Scouts WA, its
Members, employees and agents against all actions, suits, claims and demands arising out of any accident,
illness or death which may occur to the applicant during or as a result of the applicant participating in any
activity or function connected with Scouting. This includes travelling to or from such activity or function.
Medical Authority
I further authorise any Member, employee or agent of Scouts WA, in the event of any accident or illness, to
obtain medical assistance or treatment for the applicant as may be considered necessary. This includes to
engage any doctors' or nurses' assistance and to request ambulance transport and / or hospital
accommodation. In this event, I agree to pay Scouts WA on demand all such doctors' fees, nurses' fees,
ambulance fees, hospital fees and other expenses.
I have read and agree to the above privacy policy, indemnity and medical authority of Scouts WA.
Parent / Guardian Sign Date
Print Name
Privacy Policy
Personal information is collected primarily for the purpose of considering your child's application for membership of
Scouts WA and this information will be treated strictly in accordance with Scouts WA Privacy Policy. A copy of that Privacy
Policy may be obtained by visiting our website at www.scoutswa.com.au. At any time upon written request you may gain
access to the information Scouts WA holds about you in accordance with the Privacy Act 1988 (Cwth) and the National
Privacy Principles.
I do not consent to photographic / video footage of the applicant being taken and used for promotional purposes
by Scouts WA
Use of Images
Please complete and return to the Group Leader or Section Leader.
Group Leader to forward to Branch Office once details have been entered on Scoutrak.
A copy should be retained for the Group's Records.
I / we are willing to assist Scouts WA in the following areas by:
Volunteer as a Leader within Scouting
Assisting Leaders on meeting nights and activities as an
Adult Helper
Volunteer as a member of the Group support Committee
Assisting with fundraising activities / hall maintenance etc
Other - please specify ___________________________________________________________________________________
Where did the new recruit hear about Scouts? Other discription