West Lancashire Adult Training & Support Application Form

Name of course required......

Date(s) of course required ………………………………………………………….

Full Name (Mr / Mrs / Miss)
Full Address (including post code)
Email Address
Telephone Number (including STD code) and Mobile number
Date of Birth / Religion
Special Needs (eg. Mobility/diet)
Any medical conditions we should know about?
District / Blackpool / Group
Current position in Scouting
Emergency Contact Name, Address, Phone(in case of accident / illness while on the course)
Please note your details may be passed onto other course participants – please tick here if you DO NOT want that to happen
Signature Applicant / Date
Signature Group Scout Leader / Date
Signature of Local Training Manager / Date

Modules - please tick the modules that you require in this session.

Getting Started – Fee £10 payable to Blackpool District / Sectional Training - fee £25 per weekend or £10 per day.
1 / Scouting Essentials / Please note the fee for the Beaver Scout & (all) Scout
2 / Personal Learning Plan / courses is £35 total to cover the day and the weekend
3 / Tools for the job (Section Leaders) / or the whole 3 day Scout course.
4 / Tools for the job (Managers) / 11 / Administration (Section Leaders)
12 / Providing a Balanced Programme
All Appointments - fee £10 / 13 / Growing the Movement (Section Leaders)
5 / Fundamental Values of Scouting / 14 / Young People Today
6 / Changes in Scouting / 15 / Challenging Behaviour
7 / Valuing Diversity / 16 / Nights Away
8 / Skills of Leadership / 17 / Activities Outdoors
9 / Working with Adults / 18 / Practical Skills
External Certificate required / 19 / International
10 / First Aid
I enclose fee of £ ......
Cheques payable to “WLCSC LT Acc” for Modules 5 to 9, 11 to 19, 20 to 21 or Module 38 / If you wish to attend just ONE evening module (please see the web site for details) the cost is £5.
Please note the closing date for these modules is 2 weeks before the date.
Please return this form with full payment, after signature by the GSL, to your Local Training Manager, at least 4 WEEKS before the course.
Any forms received without the payment enclosed will be returned and a place on the course will not be guaranteed. / Managers, Section Supporters and Other Supporters
- fee £50 total to cover two weekends
20 / Administration (Managers)
21 / Growing the Movement (Managers)
22 / Section Support
Additional Module – fee £25 for the weekend / 23 / Safety for Managers and Supporters
38 / Skills for Residential Experiences / 24 / Managing Adults
25 / Assessing Learning
Please return to: / 26 / Supporting Adults
Dorothy Mather at

Or
238 Bloomfield Road, Blackpool, Lancs FY1 6GQ /

Office Use only: Dbase comp  Email acknowledgement sent  Chq/cash recd West Lancs Modular Training