VICTORIA SCOUT GROUP Sta Domenica Street, Victoria, Gozo. Tel: 21 55 64 97
APPLIKAZZJONI GĦALL -KAMP PERMESS TAL-ĠENITURI Lill-Ġroup Scout Leader, Victoria Scout Group, Triq Santa Domenica, Rabat – GĦAWDEX
Jien hawn taħt iffirmat, nagħti permess lit-tifel tiegħi, ikun jista’ jattendi għallser isir . Ma din l-applikazzjoni qiegħed nibghat il-ħlas ta’ €
Firma tal-ġenitur jew gwardjan
Rimarki:
nhar
biex li
għas-sehem ta’ ibni.
/ / Data (ġurnata/xħar/sena)
VICTORIA SCOUT GROUP Sta Domenica Street, Victoria, Gozo. Tel: 21 55 64 97
KUNFIDENZJALI Il-ġenituri tal-membri huma ġentilment mitluba jimlew din il-formola bir-reqqa. Dawn id-dettalji huma ntiżi sabiex ma nipperikolawx is-saħħa tal-membri waqt l-attivitajiet tagħna. L-informazzjoni mgħotija tinżamm kunfidenzjali u tkun magħrufa biss mill-iScouter li jieħu ħsieb.
FOMOLA DWAR L-I STAT T A’ SAĦĦA Isem l-Iscout:
Età:
Grupp tad-Demm:
Immarka fejn jaqbel, jekk ibnek ibati b’xi waħda minn dawn il-kundizzjonijiet. Ażma Mard tal-Qalb Sturdament Uġiegħ tal-Widna Hay Fever Bed Wetting
Dijabete Problemi tas-Sider Dijarea Uġiegħ ta’ Stonku Sinusite
Qtuh ta’ Nifs
Epilessija Rewmatiżmu Jinfaġar Uġiegħ ta’ Ras Ħmar il-Lejl
Xi uġiegħ waqt ezerċizzju?
Uġiegħ? Allerġiji?
Għejja mhux normali
Jekk IVA, għid għal xhiex:
Antibijotiċi Mediċini oħra Ikel Xi kundizzjoni oħra li mhix imniżżla hawn fuq? X’medicini qed jieħu ibnek bħal issa? Meta ingħata l-aħħar tilqima tat-Tetanus?
Dikjarazzjoni: L-informazzjoni mgħotija hawn fuq, hija, sa fejn naf jien, tajba. 1. F’kaz li ibni jkollu xi problemi in konnesjoni mal-kundizzjonijiet mniżżla fuq, nissuġġerixxi li: 2. Jekk f’każ ta’ emergenza, ma tkunux tistgħu tikkuntattjawni, jiena nagħti l-permess lill-iScouter li jkun jieħu ħsieb sabiex jieħu lill-ibni għand it-tabib jew l-isptar għal kura meħtieġa. It-tabib tal-familja huwa Dr Tel: Jiena niddikjara illi qrajt bir-reqqa din il-formola u nifhem illi fil-każ li din il-formola ma ġietx mimlija korrettament, dan jista’ jikkomporta perġudizzju lill-ibni. Għaldaqstant jiena neżenta lill-Victoria Scout Group u lill-uffiċjali tiegħu minn kull responsabilita’ minħabba kull konsegwenza illi tista’ tirriżulta minħabba in-nuqqas tiegħi illi nimla’ din il-formola kif dovut. Firma tal-ġenitur jew gwardjan
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