Seaside Family Camp - Eastbourne District Scouts

1st Seaside Family Camp

Permission / Medical Form.

This form must be completed for each child by a parent/guardian, it must also be completed by all adults/leaders attending the event (adults please ignore or put 'na' in any fields not relevant to you).

All data is stored securely and handled in accordance with the Data Protection Act and General Data Protection Regulation (GDPR), and will be disposed of immediately after the event.

Participant Information

Please complete as much of the information as possible.

Participant Name*

Date of Birth*

Parent Name*

Parent Email*

Home Address*

Doctor Details

Please complete as much of the information as possible.

Doctor Name

Doctor Address

Doctor Telephone

NHS Number

Medical Information

Please complete as much of the information as possible.

Any contact with infectious diseases within the last 3 weeks ?* Yes No

Infectious Disease Details

Medical History

Medicines currently being taken

Date of last Tetanus Immunisation

Allergies

Special Dietary Needs

Any other special needs

Emergency Contact

Please provide details of at least one emergency contact/next of kin during the event.

Contact Name*

Contact Address

Contact Telephone*

Contact Mobile

Alternate Contact Name

Alternate Contact Address

Alternate Telephone

Alternate Mobile

Treatment Permission

Please give your consent that in the event of an incident requiring first aid or medical attention you authorise the trained medical staff/doctor/First Aid staff to undertake whatever treatment is considered necessary for your child, (including use of EPIPEN). If it becomes necessary for further medical treatment and you cannot be contacted to authorise this, you also give your general consent to any necessary medical treatment and authorise the Leader in charge to sign any document required by the hospital authorities.*

*Note: The medical profession takes the view that the parent’s/carer’s consent to medical treatment cannot be delegated. This view is explicit in The Children’s Act 1989. Thus, medical consent forms have no legal status and a doctor or nurse insisting on the consent of a parent/carer to a particular treatment has the right to do so. However, it can be a comfort to medical staff to have general consent in advance from parents/carers or to have a Leader on hand able to sign forms required by medical authorities.

I consent to treatment* Yes No

Air Rifle Shooting Permission

Please sign to confirm the following declaration;

I, being the parent/guardian of the young person named above, declare that he/she is not subject to restriction by virtue of Section 21 of the Firearms Act 1968 (which applies only to persons who have been sentenced to a term of imprisonment or youth custody) and give permission for him/her to take part in Air Rifle Shooting.

Shooting Permission* Yes No

Activity Permissions

Please select below the activities you give permission for your child to take part in, all are run in accordance with Scout Association policies using qualified instructors. By submitting this form you also give general permission for your child to take part in the other non-adventurous activities that will be at the event.

Climbing / Abseiling Permission* Yes No

Archery Permission* Yes No

Please confirm you are human and then press 'Submit'

Thank-you for submitting your form, you will also receive an email confirmation.

SEE YOU AT THE EVENT!