CS Diamond/DofE Silver and King’s Scout/DofE Gold Expeditions

NIEX 2024

Participants Name(Required)

Date of birth(Required)

Age on 10 Feb 2024(Required)

Section(Required)

Explorer Scouts

Network

If Network please provide your membership number

Expedition Level(Required)

Diamond (Silver)

King's Scout (Gold)

If King's Scout Expedition please select your location preference

Lake District

Scottish Highlands

Wicklow Mountains

Address(Required)

Street Address City County / State / Region ZIP / Postal Code

Participant's Email(Required)

Home Phone(Required)

Participants Mobile(Required)

Any health issues? (asthma, allergies, diabetes, disabilities, dietary restrictions etc)(Required)

Parent/Guardian/Next of Kin name(Required)

Address (if different from above)

Street Address City County / State / Region ZIP / Postal Code

Parent/Guardian/Next of Kin Email(Required)

Home Phone(Required)

Parent/Guardian/Next of Kin Mobile(Required)

Parent/Guardian/Next of Kin Name who gave consent(Required)

First Last

Today's Date(Required)