7/30/2019 Equinox Permission Form

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Please return the lower section of this form by (date) 10/01/2013 to the camp leader (name) Dave

At (address)__9 Priory Close, Bebington, Wirral________ Tel _07922 44 8702_

Name of Group: Bebington District Explorers Event __Equinox Challenge and Camp__

Will take place at (address) Forest Camp, Sandiway____________________________________________________________

from (date)_22/02/13______________ to (date)__24/02/13_____________

Meeting place _Forest Camp, Sandiway________ at (time) _1900 hrs____________________________

Cost of the event will be __26.00__________________________

The balance and form need to be returned to the camp leader by (date) _10/01/2013____________________________

Home Contact (if required)__All contact through camp leader on above number___________________

All activities will be run in accordance with The Scout Associations safety rules. No responsibility for the personal

equipment/clothing and effects can be accepted by the camp organizers and The Scout Association does not provide automaticinsurance cover in respect to such items.

(Please cut Here)

_______________________________________________________________ ____________________________________________________________________________

I give permission for (name of child) __________________________ to attend the camp/holiday between

the (date)______________ and (date) ____________________ at (location)________________________

Parent/Guardians address during the event

Address_________________________________________________________________________________

___________________________________________ Telephone Number____________________________

Childs DOB ______________ NHS Number ___________________

Date of last Tetanus injection ____________________

Medical Details (including allergies eg penicillin, disabilities,dietary needs eg no nuts, or Special Needs)

________________________________________________________________________________________

________________________________________________________________________________________

Doctors Name, Address and Telephone number ________________________________________________

_______________________________________________________________________________________

He/She can/cannot swim 50 metres and tread water

He/She may/may not bathe under careful supervision.

I understand that the Camp Leader reserves the right to send any participants home if the behavior of the participant is deemed

unacceptable. I also understand that if it becomes necessary for my child to receive medical treatment and I cannot be contacted

by telephone or any other means in order to authorise this, I hereby give my general consent to any necessary medical treatment

to be administered, and authorise the Scouter in charge of the camp to sign any document required by the hospital authorities.

Name of Parent/Guardian __________________________ Signature_________________________ Date ___________________