12TH WALLASEY SCOUT GROUP

Please indicate your child's section:

Cub Section (12th Wallasey only)
Scout Section (12th Wallasey only)
Explorer Scout

First name of the young member (separate forms for each member please)

Enter last name of the young member:

Postcode:

Address, including town, county & country:

Home phone number:

Mobile number for young person (EXPLORERS ONLY)

Mobile number of parent:

Email address of parent:

Personal Email address (Explorers Only):

Gender

Female
Male
Prefer Not To Say

Date of Birth:

Scout Membership Number (Adults & Leaders Only):

Permissions & Abilities

The young person named above can swim 50 metres and treat water?

Yes
No
Don't Know

The young person named above may take part in planned water activities under supervision:

Yes
No

The young person named above may take part in the planned shooting activities under supervision:

Yes
No

Health & Allergise Information

Please tick if the young person named above has any of the following health conditions:

Asthma
Epilepsy
Diabetes

Date of last Tetanus (if not know, an approximate year will help):

Name of Emergency Contact during the event:

Relationship of emergency contact to young member:

Full address of emergency contact:

Emergency contact's landline telephone number:

Emergency contact's mobile telephone number:

Name of the young members Doctor

Address & Telephone number of young members Doctor

Detail any and all allergies to medicine the young person above has:

Detail any and all allergies to food the young person above has:

Detail any and all special dietary needs the young person above has:

Detail any and all other special needs the young person above has:

If I have granted permission above, I declare that this young person is not subject to restriction by virtue of Section 21 of the Firearms Act 1968 (which applies only to persons who have served a term of imprisonment or youth custody) and give permission for them to undertake Air Rifle Shooting and Laser Clay Shooting.

I understand that the Camp Leader or Deputy reserves the right to send any participants home if necessary.

If it becomes necessary for my child to receive emergency 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 to sign any documents required by the NHS.

During Chamboree 2018 there will be photographic and video recording of the event. Guidelines will be issued to those attending the camp about the appropriate use of cameras and recording equipment. Any inappropriate use will result in pictures/recordings being confiscated and those involved will be required to leave the site. However, attendance at Chamboree automatically grants permission for likenesses and voices to be included in pictures/recordings of the event.

Signature of parent / guardian: (please write your full name and note this will be treated as an electronic signature in you agreeing to all of the above information).

Once you have submitted this form, it will be emailed to you for checking.