PERMISSION TO CAMP FORM

(top section to be kept by parents for information)

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 automatic
insurance 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 ___________________