Scouts South Africa Consent And Indemnity Form Events And Activities printable pdf download

Consent and Indemnity Form

Events and Activities

To the Regional Commissioner, Scouter,

I, (Full names of Parent / Legal Guardian)

of (Address)

Postal Code

Home Telephone

Cell Number

being the Parent / Legal Guardian of (minor child’s full name), hereinafter referred to as ‘Ward’,

a member of the

Group,

hereby permit him/ her to partake in the activity/camp referred to below

Camp/Activity:

Date/Duration

Location/Venue

I hereby appoint and authorise the Scouter, Chairman or Commissioner in charge to act in my place as parent/guardian with

full authority to consent to my Ward undergoing surgical and/or medical treatment. I undertake to pay the costs of such

treatment.

I hereby DO/ DO NOT give permission for my Ward to participate in any water activities.

I fully understand and accept that all activities are undertaken at my Wards own risk.

I am aware that neither SCOUTS South Africa, nor its Chairmen, Commissioners, Scouters, agents, employees, volunteers or

any person associated with SCOUTS South Africa accept responsibility for any loss, injury or damage that the person or

property of my Ward may sustain whilst engaged in any Scouting, including inter-alia transport to and from the activity.

I hereby waive any right that I or my Ward may have to claim compensation against SCOUTS South Africa or its Chairmen,

Commissioners, Scouters, agents, employees, volunteers or other members, in respect of any loss, injury or damage incurred

whilst engaged in any Scouting activity howsoever arising and whether as a result of negligence or otherwise and I indemnify

SCOUTS South Africa against all such claims.

I agree and authorize that photo’s, statements, audio – visual recordings, video and sound bites taken, recorded and

collected from my Ward during activities with SCOUTS South Africa may be used free of charge and at the discretion of

SCOUTS South Africa as part of their marketing, communication and fundraising campaigns.

Signed: __________________________________

Witness: ____________________________________

Mother/Father/Legal Guardian

Dated this _______________________ Day of _________________________________ 20 ______________

Name Doctor

Tel No

Preferred Hospital

Medical Aid Scheme

Medical Aid Number

Med Aid Prinicpal Member

Page 1/2

E-mail: .za

Website:

Tel: 0860 SCOUTS

2013/v1

Scouts South Africa Consent And Indemnity Form Events And Activities

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