Form Tr1 - Leader Training Application - Scouts Australia
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1
2SCOUTS AUSTRALIA
FORM TR1
Dec 2012/ks
Victorian Branch
LEADER TRAINING APPLICATION
Scout Code Number
Registration Number
NAME OF APPLICANT
Mr
Mrs
Ms
Miss
COURSE APPLIED FOR
Section
_______________________________________
Surname
_____________________________________________
Title of Course _______________________________________
First Given Name
_____________________________________________
Date/s
_______________________________________
Second Given Name
_____________________________________________
Location
_______________________________________
Applicants for introduction to Scouting Seminars should note that acceptance for this course must not in itself be interpreted as an authorization to act as an
Adult Leader in the Scout Association or to purchase and wear Scout uniform.
APPLICANT’S PARTICULARS
Postal Address
_________________________________________________________
Group ______________________________________
Town /Surburb
___________________________ Postcode
___________________
District ______________________________________
Region ______________________________________
Private Telephone
___________________________ Bus. Ph.
___________________
Present / Intended Leader Position ________________
Fax Number
___________________________ Mobile
___________________
________________________________________
Email
_________________________________________________________
Date of Birth (31 Oct 84 to 311084)
Occupation ______________________
Religion __________________________
I have read and understood the rules and conditions relating to training contained within the current Information Handbook
Signature of Applicant:
__________________________________________________________________________ Date
________________
Group or District Approval:
__________________________________________________________________________ Date
________________
District Confirmation of Eligibility _________________________________________________________________________ Date
________________
INFORMATION TO ASSIST THE COURSE LEADER
Preferred Name (For Course Name Tag )
______________________________________________________________________________________
Medical / Physical Limitations of Applicant:
______________________________________________________________________________________
Special Dietary Particulars
______________________________________________________________________________________
To assist the Training Course Team with planning please indicate below what you feel are your particular needs
Knowledge needs
_________________________________________________________________________________________________________
Skills Needs
_________________________________________________________________________________________________________
Other Needs
_________________________________________________________________________________________________________
Prior learning relevant to course
____________________________________________________________________________________________
PAYMENT:
Please make cheques payable to Scout Association, Victorian Branch
Please note: Credit Card payments are not
available for all Training Courses
CREDIT CARD
CHEQUE
CASH
Type of Card -
Visa
M/Card
Amex
Diners
Amount $ _________________
Name on Card ______________________________________________
Card Holder’s Signature __________________________________________
CCV
Card No.
Expiry Date
*The CVV No. for Visa, MasterCard, Diners is the last 3 digits on the signature strip at the back of the Credit Card
For Amex it is printed (NOT embossed) group of four digits on the front of the card towards the right.
Course Fee $ …………………… Payment Received $ ………………………. Cash
Cheque
Receipt No …………….
Refund No …………….
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