ACTIVITY INFORMATION This part to be kept by parent/guardian. Please complete legibly in black ink. Please return the lower section of this form, completed and signed by ...................... Camp Leader (name): Address: Telephone number: The (name of event):
Will take place at (postal adaddress): From: To: Leaving from (place): At (time): Cost £ . With a deposit of £ …………. To be paid by (date): With the balance paid by (date): The Home Contact if necessary is Name: Address: . Additional information about the event and activities: .............................................................................................................................................. This part to be returned to the Leader I give permission for (name of child): ………………………………..……….….. to attend the camp/holiday at: ……………. from: To: Has she/he been in contact with any infectious diseases within the 3 weeks?: ……….……………… Date of last tetanus immunisation: ………….………….... Medicines currently being taken: ………….…..…………. Does she/he have any allergies to food, medicines or other Does she/he have any special dietary needs? Does she/he have any special needs? Please continue overleaf if necessary: She /he can/can not swim 50 metres and tread water. Yes / No She/he may/may not bathe under careful supervision. Yes / No Name, address and telephone number of own Doctor: Date of birth: During the event I can be contacted in an emergency at: Telephone number: Signature of parent/guardian …………………………… Date: I understand that the Activity Leader reserves the right to send any participants home if necessary. If it becomes necessary for my child to receive medical treatment and I cannot be contacted by telephone or any other means to authorise this, I hereby give my general consent to any necessary medical treatment and authorise the Scouter in charge of the camp to sign any document required by the hospital authorities. Note: The medical profession takes the view that the parent’s consent to medical treatment cannot be delegated. This view is explicit in the Children Act 1989. Thus medical consent forms have no legal status and a doctor/nurse insisting on the consent of a parent to a particular treatment has the right to do so. For this reason we do not recommend that Leaders insist on parents signing the statement above. However, it can be a comfort to medical staff to have general consent in advance from parents or to have a Leader on hand able to sign forms required by medical authorities. 1/2 Camp/Holiday Information � The Scout Association 1999 – Item code: FS120082 April 97 Format revision Jan 2000 The Scout Association, Information Centre, Gilwell Park, Bury Road, Chingford, London E4 7QW. Email: info.centre@scout.org.uk Website www.scoutbase.org.uk Direct: 020 8498 5400 Local rate call: 0845 300 1818 Fax: 020 8498 5407 2/2 Camp/Holiday Information � The Scout Association 1999 – Item code: FS120082 April 97 Format revision Jan 2000 The Scout Association, Information Centre, Gilwell Park, Bury Road, Chingford, London E4 7QW. Email: info.centre@scout.org.uk Website www.scoutbase.org.uk Direct: 020 8498 5400 Local rate call: 0845 300 1818 Fax: 020 8498 5407 |