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Petworth & Pulborough Scout District

Building #SkillsforLife in West Sussex

If you wish to gain a permit to lead an adventurous activity, please fill in this form.

Details of how to find an activity assessor can be found in factsheet FS120101 Adventurous Activity Permit Scheme - HERE

A - Personal Details

* First Name:
* Surname:
* Email:
Home Tel No.:
Work Tel No.:
Mobile Tel No.:
* Date of Birth:
* Address:
Health Factors:
(things that may affect running Nights Away events)
* District / County:
DC or CC Name:
Tel. No.:



B - Activity Details

Permit Applied For:
See FS120100
Any Restrictions Wanted:

(E.g. Site/route specific, group sizes, geographic, conditions, etc.)



C - 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.

Permit Type:
See FS120100
Expiry Date:
Restrictions:

(E.g. Site specific, group sizes, geographic, conditions, etc.)



D - Qualification 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.

Qualification:
Award Body:
Date Gained:
Qualification:
Award Body:
Date Gained:
Qualification:
Award Body:
Date Gained:
Qualification:
Award Body:
Date Gained:



E - Logged Experience

Please enter details of all recent logged experience.

Date:
Event:
Role:
Brief Details:
Date:
Event:
Role:
Brief Details:
Date:
Event:
Role:
Brief Details:
Date:
Event:
Role:
Brief Details:

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Petworth & Pulborough Scout District
West Sussex County Scouts, Lodge Hill, London Road, Watersfield, Pulborough, West Sussex, RH20 1LZ
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