The Scout Association of Australia, Queensland Branch Inc.
Form: C4
Issue: 10
Notification Of Camp / Outdoor Activity
Date: 03/15
A
Part
PARENTS COPY
Dear Parent/Guardian, The following are arrangements for the next Troop/Patrol Camp/Hike
Place:
DURATION
From:
To:
ASSEMBLY
Location:
Time
RETURN
Location:
Time:
Activity under control of Adult Leader/Patrol Leader:
Cost:
$
Once this amount is paid and provisions purchased, no refund will be made through non‐attendance at the respective activity
except in special circumstances.
B
Part
LEADERS COPY
This Form To Be Filled In By Parent(S) Or Guardian(S) And Returned, Together With Camp Fee To The Leader‐In‐Charge
By
I approve of
(Scouts Name)
Address:
Attending camp from:
to
Should the necessity arise, I can be contacted at:
Phone
Mobile
I submit the following details for your attention:
Medicare No.
Date of last Tetanus Injection:
Points in the Scout’s health or behaviour requiring some special attention:
Details of any medication and dosage that will be carried:
The program will contain the indicated adventurous activities requiring specific approval. Initial adjacent to activity
Swimming
Pioneering
Archery
Canoe/Kayak
Bushwalking
4WD
Abseiling
Snorkelling
Rock Climbing
Caving
In the event of injury to the Youth Member, where reasonable attempts to contact me are unsuccessful I give authority for such
medical treatment to be given to the youth member as is recommended by a medical practitioner and seems in the opinion of the
leader in charge to be reasonable and appropriate. I undertake to be responsible for any fees or charges with respect to that
treatment and to pay those costs on demand by the Association.
Signature of parent, caregiver or guardian:
Date:
Signature of parent, caregiver or guardian:
Date:
(If no second signature, please state a reason. for example, single parent)