Camp /Night Away Location: Tawd Vale Scout Camp, Lowry Hill Lane, Lathom, Lancs, L40 5UL
Date(s): Saturday 23 July 2016 to Friday 29th July 2016 (Beavers 23rd-24th / Cubs 23rd-26th)
Camp / Night Away Leader in Charge: Andrew Pickersgill (Hawkeye)
Additional Leaders/Helpers Attending: Steve, Annette, Pol, Tommy, Alison, Ian, Sue, Carla, Lucy, Alex, Lezleigh, Kev
The section below should be completed by the Parent or Guardian of the young person named below. Please answer all of the following questions as fully as possible. As in the event of your child requiring emergency treatment, it will help the medical authorities in deciding which is the most appropriate treatment to give.
Please select your child's section:
Full Name of Young Member
Date of Birth of Young Member
Parent/Guardian Full Name (Emergency Contact 1)
Parent/Guardian Address during Camp / Night Away
Parent/Guardian Landline or Mobile Phone Number
Parent/Guardian email address (Emergency Contact 1)
Full Name of Second Emergency Contact
Relationship of Second Emergency Contact to Young Person named above
Second Emergency Conact Landline or Mobile Phone Number
Full Name and Address of Family Doctor
Family Doctor's telephone number
Date of Last Tetanus Injection
Please indicate any allergies your child has:
Details of any medication or medical treatment currently being taken:
Details of any disabilities, health conditions, allergies, special needs or cultural needs that might affect this event:
Details of any infectious diseases he/she has come into contact with in the last three weeks:
The Camp / Nights Away Leader (or in their absence one of the assistant leaders named above) may administer the appropriate minor treatment/precautions (as listed below) if required (please select the treatments below only if you agree with them being administered to your child where appropriate to do so).
I understand that photographs and videos may be taken during the camp / night away. I also understand that these may be used on the group social media accounts, and for publicity purposes, including the local press and social media, in which your child can be identified. Please select the appropriate response below:
Disclaimer: If it becomes necessary for the above named young person to receive medical treatment and I cannot be contacted to authorise this, I hereby give my general consent to any necessary medical treatment and authorise the Leader in Charge to sign any document required by the hospital authorities. I have provided all of my child’s medical information and my child is fit to participate in the camp / night away.
Signed Electronically By:
Insert Date of Signing
Additional Supporting Information Where Required:
I will inform the Camp / Night Away Leader if any of the information given on this form changes before the event takes place.