Adventurous Activity Permit Application

Application Date

First Name

Last Name

Date*

Email Address

Address*

Street Address Address Line 2 City County Post Code

Home Number

Mobile Number

Work Number

Health Factors (things that may affect the activity)

Scouting District (or County for County appointments)

DC (or CC for County appointments)

Activity Details

Activity Permit Applied for (from FS120100)

Any Restrictions Wanted

Renewal Details

If you are applying for a permit exactly the same as one you currently have, or as one that has just expired, please give details here. You will be required to show proof of this permit when you meet with the assessor.

Activity Permit

Expiry Date

Restrictions

Qualification Details

If you have any relevant activity specific qualifications (such as National Governing Body Awards), please give details here. You will be required to show proof of these qualifications when you meet with the assessor.

Qualifications

Name

This field is for validation purposes and should be left unchanged.

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Adventurous Activity Permit Application

Adventurous Activity Permit Application

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Module 12A – Delivering a Quality Programme

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Module 15 – Promoting Positive Behaviour

‘Nature and the outdoors are languages that can be learned. Once you identify a beech tree, tie a clove hitch or cook a simple meal over a fire that you’ve built yourself, you’ll never forget it.'