Form C: YOUNG PERSON PERMISSION FORM

18th – 20th May 2018

Bramcote (Gamecock) Barracks,

Nuneaton CV11 6QN

Form C: YOUNG PERSON PERMISSION FORM

Young Person includes Beavers,Cubs, Scouts, Explorers, Leader’s Children and Young Leaders.

This form needs to be completed for each Young Person attending the Camp, and retained by the Leader in Charge of each Pack.

Surname: / First Name:
Address:
Postcode:
Tel No:
Date of Birth: / / / / Gender: / Male/Female (delete as appropriate)
Name of Doctor:
Surgery Address:
Surgery Tel No:
NHS Number: / Approx date of last Tetanus injection:
If the above person has been in contact with any infectious diseases that you believe we should be made aware of please inform your leader prior to arrival.
List any known allergies/sensitivities, e.g. penicillin/Elastoplast/foods:
Is the above person undergoing any current or recently has any medical treatment which the medical team should know about YES/NO
If yes please give details, include doctor or hospital (continue on a separate sheet if necessary)
Does the above person suffer from asthma, chest complaint, hay fever, migraine, fits or faints, diabetes, nervous disorder or any other illness or disability
Please declare any other relevant information that you think the organisers should know about.

Continued overleaf

In the event of any serious accident please contact the following person who is available during the weekend 18th – 20th May 2018.
Name:
Address:
Postcode:
Tel Nos: / Daytime: / Night:
Relationship:

I understand that Get In 2018 is a weekend of activities for members of the Scout Association.

During the weekend there may be the opportunity to undertake rifle target/laser clay shooting and archery – if you do not wish your son/daughter to participate in these activities or they are restricted 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) please tick the box below. The organisers must formally disclaim any responsibility whatsoever for any loss, injury or loss of life during the weekend. The activities will be run under the rules of the Scout Association and those who are currently members of the Scout Movement will be covered in the normal way by the Association’s insurance.

I give permission for my son/daughter to participate in target rifle shooting, laser clay shooting or archery, please tick here: ☐

There may be an opportunity to undertake water activities e.g. kayaking.

I give permission for my son/daughter to take part and I have read the additional water activities health information, please tick here: ☐

On occasions, photographs, videos and audio of Scouts taking part in activities may be submitted to the local newspapers, the Group, District or County newsletters, websites, social media or put on display.If you have any objections please indicate you are not willing for your child's image to be used in this way by ticking the box. Please tick here: ☐

If there is a safeguarding reason why your child cannot be photographed please supply your Leader with a digital photo to be held securely at camp control for reference.

I give my permission for an Organiser/Leader to sign on my behalf any written form of consent required by the hospital/medical authorities, if the delay required to obtain my signature was considered inadvisable by the Doctor concerned.

Parent / Guardian Signature:
Parent / Guardian Name:
Date:

I give permission for my photograph to be used for publicity purposes, as per above.

Please tick here: ☐

Young Person Aged 16 and over Signature:
Date:

Additional Health Information for Water Activities is overleaf

Water Activities – Additional Health Information.

Diseases Known to water.

Weil’s disease is a bacterial infection carried in rat’s urine which contaminates water and wet river banks. The bacteria do not survive for long in dry conditions. It can be a serious illness requiring hospital treatment, and it can lead to kidney or liver failure. The bacteria are absorbed through the skin or mucous membranes of the mouth and eyes .It gets into the blood stream very easily through cuts on your skin or feet, if you become immersed. If you feel ill after your water activity, particularly in stagnant waters and pools or have any of the following symptoms call your doctor. The most common early symptoms are high temperature, an influenza- type illness and muscle pains. Tell your doctor that you have been undertaking water activities and where and ask if you can have a blood test for Weil’s disease.

PREVENTION

Prevention measures are largely common sense.

Cover all cuts and abrasions with waterproof plasters.

Always wear footwear to avoid cutting the feet.

Were possible shower soon after the activity.

The most important thing to do is think hygienically and wash hands and face before eating and shower if you fall in.