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           Cheshire County Scout Council                                                              

                        Adult Training                                                                                             

                                                                                                        10 October 2006    10NA(BS)                                                                                                                     

Registration Form for Modular Training - Nights Away (BS only)

To be completed by – LEADERS IN THE BS SECTION 

Full Name:                   _________________________________ (Mr/Mrs/Ms/Miss/Others)  ____________

Address:                       ___________________________________________________________________

Postal Code:                _____________________      e-mail address:  _____________________________           

Tel. Number:                0____________________      Date of Birth:     ____/ ____/ 19___

Scout Group:               ________________________ Scout District:  _____________________________

Registered Adult Training Zone:  __________________________________ (Nearest zone to where I live)

_______________________________________________________________________________________

I have agreed with my Training Adviser ____________________________ (name in capitals) to complete adult

training Module 16 (Nights Away), which is appropriate to my appointment as a _________________________

MODULAR GROUP - Supplementary Module (Module 16 - Nights Away)

Dates:     22 / 23 September 2007            (Days 1 & 2)               Please note that this is a residential 

    experience involving an overnight stay

Venue:    Beeston Outdoor Centre.

Signed: _____________________________ (Leader)

Date:    _____________________________                                                        

Signed: _____________________________ (Local Training Manager)

Date:    _____________________________

Dietary Needs: __________________________________________________________________________

Please state any specific requirement, which may affect your training:  ______________________________

Emergency Contact Name: ________________________________________

Contact Tel number(s) to be used: __________________________________

Address (if different from above): __________________________________________________________________

PLEASE RETURN THIS FORM WHEN COMPLETED AND SIGNED TO – Mrs Debbie Phillips,

Training Manager, Enterprise Centre, Lea Hall, Wimboldsley, Cheshire CW10 0LL.

OR e-mail – debbie@marketinggroup.co.uk

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