Permission to Camp Form

Please complete this form as fully as possible, as in the event that you may require emergency treatment, it will help the
medical authorities in deciding which is the most appropriate treatment to give. (Please complete in BLOCK CAPITALS).
Surname

Forenames

Date of Birth

National Health Service Number

Family Doctors Name and Address

Date of last Tetanus injection

Emergency Contacts Name and Address

.. ..
.. ..

Telephone Telephone

Health Please give details of the following:1.

Any known infectious diseases with which you have been in contact with, in the last three weeks
(eg. Chicken Pox, Diphtheria, Measles, Mumps, Rubella, Whooping Cough, etc.).

2.

Any known allergies / sensitivities / disabilities and details of any known precautions or remedies
(eg. Penicillin, food colourings, travel sickness, bed-wetting, Asthma, etc.).

3.

Details of any medicines / diets / treatments currently being taken / followed (including dosage details) and the Specialist
and / or Hospital concerned if appropriate (please include any non-prescription preparations, such as cough sweets,
herbal medicines, etc.).
.
.
.

Continue on a separate sheet if required. (Include your name on any separate sheets and attach them securely to this form).

Activities (If you are under 18, this section must be completed by your Parent or Guardian)
I give permission for the afore mentioned person to partake in the following activities (Tick to indicate permission):
Shooting

Archery

Swimming

Name

Signature

Canoeing

Caving

Climbing

Date

If it becomes necessary that I need to receive medical treatment, I hereby give my general consent to any necessary medical
treatment and authorise the Camp Leader (or in their absence one of the assistant Camp Leaders) to sign any document required
by the hospital authorities. I will inform the Camp Leader if any of the information given on this form changes. The Camp Leader
reserves the right to send any one attending the camp home in the case of dangerous or poor behaviour.
If the camper is under 18 this form must be checked and signed by their Parent or Guardian.
Name of Parent or Guardian

Signature

Relationship to Camper

Date

NOTE: The Medical Profession takes the view that a Parents consent to medical treatment cannot be delegated. This
view is explicit in the Children Act 1989. Thus medical consent forms have no legal status and a Doctor / Nurse insisting
on the consent of the Parent or Guardian has the right to do so. For this reason we do not recommend that Leaders
insist on Parents signing the statement above. At the same time, it can be a comfort to medical staff to have general
consent in advance from Parents or to have a Leader on hand able to sign forms required by the medical authorities.
(This statement is in bold print as suggested by Scout Headquarters).