Trial Form

Name*
I give permission for the child named below to attend this 1st Woodend activity
Date of birth*
DD slash MM slash YYYY
1. Has he/she been in contact with any infectious diseases with 3 weeks?*
- No
- Yes
If Yes, please state the infectious disease
2. Please list any medicines currently being taken including the dosage & times of day the medicines are taken. If none please type in NONE.*
3. Does he/she have any allergies to food, medicines or other?
- No
- Yes
If Yes, please state the allergy
4. Does he/she have any other dietary needs?*
- No
- Yes
If Yes, please state his/her dietary needs
5. Are there any further details we need to know about?
Consent*
I agree to my young person attending the camp/event and acknowledge the information below.
I understand that the Camp Leader reserves the right to send any participants home if necessary.
If it becomes necessary for my child to receive medical treatment and I cannot be contacted by telephone or any other means to authorise this, I hereby give my general consent to any necessary medical treatment and authorise the Scouter in charge of the camp to sign any documentation requires by the hospital authorities.

Place to belong