Durham Scout Events Medical & Permission Form – Under 18 [To be completed by a parent or guardian] Surname

First Names

Group

Date of birth

Email Address

Dietary Needs (including vegetarian). Please list any food allergies.

Home Address

Parent/Guardians Name

……………………………………………………………….

Family Doctor’s Name and Address ……………………………………………………………….

Home Tel No. ……………………………………………………………….

……………………………………………………………….

……………………………………………………………….

………………………………………………………………. Parent/Guardian Mobile

……………………………………………………………….

……………………………………………………………….

(if different on date of camp please use back of form) Information for our onsite first-aider (e.g. allergy to sticking plaster)

Medical Conditions / Physical Restrictions

Any prescribed medication to taken during camp?

Will your child bring any non-prescribed medication to camp? If yes, what?

(prescribed medication must have original pharmacy labels intact)

 Yes  No

Specific Consent (tick box if you give your consent)



My son/daughter has my permission to take part in this camp and take part in its activities. I understand that the camp leader will always act to ensure the enjoyment and safety of everyone and therefore reserves the right to send any participant home.



I agree to inform the camp leader if any of the information on this form changes before the camp takes place.



If it becomes necessary for my son/daughter to receive medical treatment, and I cannot be contacted by telephone or any other means to authorise this, I give my general consent to necessary medical treatment and authorise the camp leader to sign documents required by hospital staff on my behalf.



Photograph Policy During the event, photographers will be taking still and moving pictures that may be used during and after the camp in Scout Association publicity or publications, or in local newspapers, or on Scout Association websites. Local newspapers and TV stations may also attend the camp to provide external media cover - members of the press will be accompanied at all times by a member of the event staff/leader team. In line with Scout Association guidelines, images used outside of the camp will not be accompanied by surnames or postal addresses, and first names will only be used with the express permission of individuals/parents/guardians. Anyone attending the camp, or giving permission for their child/ward to attend the camp, should note that attendance at camp signifies their agreement for photographs of themselves/their child to be used in line with the above policy.

Name of Parent/Guardian

Relationship to young person

Signed

Date

For office use Reference Activity Exemptions

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