Scout Activity Consent Form

Please complete all fields and sign before submitting.

Event Details

Event —

Location —

Date —

Young Person

Full name *

Date of birth *

Emergency Contact

Name *

Phone number *

Relationship to Young Person *

Medical Information

Doctor name & contact *

Current medications

Medical conditions, disabilities, allergies & infectious disease contact *

Loco Parentis

Do you give permission for a leader to act as loco parentis should hospital treatment be required before your arrival? *

Yes No

Permissions

Do you give permission for the following to be applied or administered to your young person if required?

Photographs

Yes No

Suncream

Yes No

Aftersun

Yes No

Ibuprofen

Yes No

Insect Repellent

Yes No

Antihistamine

Yes No

Antiseptics

Yes No

Bite/Sting Relief

Yes No

Paracetamol

Yes No

Plasters

Yes No

Signature

Please sign below *

Sign here

Date *

Your relationship to young person *

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