Scouts South Africa Consent And Indemnity Form Events And Activities Page 2

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SCOUTS South Africa
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Consent and Indemnity Form
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Events and Activities
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In the case of an emergency it is vital that the Scouter and/or person in Charge has as much
personal information as possible. It is to your own benefit to fill this in completely and accurately!
Details of Scout
Full Names
ID Nr
Date of Birth
Age
Day
Month
Year
Allergies
Medication (specific times/dosage/etc)
Previous medical conditions or any other medical conditions you feel are of relevance
Infectious Diseases
Physical Disabilities
Special Dietary Requirements
Parents Contact Details
Fathers Details
Mothers Details
Name
Home Phone
Work Phone
Cell Phone
Contact First (tick)
Alternatively contact
Page 2/2
E-mail: .za
Website:
Tel: 0860 SCOUTS
2013/v1

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