Permission To Camp Form

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Permission To Camp Form

1^st Bletchley Scout Group

Personal Details for Camp

Surname:	.......................................................	Address:	.......................................................
Name:	.......................................................		.......................................................
Date of Birth:	.......................................................		.......................................................
Parent/Guardian:	.......................................................		.......................................................
Phone (Home):	.......................................................	Phone (Mobile):	.......................................................

If the person named above is not available, in the event of an emergency, please contact:

Name:	.......................................................	Name:	.......................................................
Relationship:	.......................................................	Relationship:	.......................................................
Phone (Home):	.......................................................	Phone (Home):	.......................................................
Phone (Mobile):	.......................................................	Phone (Mobile):	.......................................................

Doctor’s Name:	.......................................................	Telephone:	.......................................................
Surgery Address:	.......................................................	National Health Number:	.......................................................
	.......................................................	Allergies:	.......................................................
	.......................................................		.......................................................

Any medical information (Past or Present):

...........................................................................................................................................................................................................

Any medication to be taken whilst away (Please list with simple instructions):

I hereby sanction the Scout Leader into whose charge I have accorded my child, to give permission for any emergency medical treatment required in my absence, or if I can not be contacted.

Signed:

.......................................................

Date:

.......................................................