Scouts Canada Parent/guardian Consent Form
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Scouts Canada
Parent/Guardian Consent Form
For Category Three Activities and Out of Country Travel
(Leaders: this is to be filed with Camping/Outdoor Activity Application)
Note: If applicant is under 18, parent or guardian must sign.
Youth’s Name:
Phone:
Address:
City:
Province:
Postal Code:
Parent/Guardian Name:
Residents of all Provinces/Territories except Quebec:
Experience has shown that in connection with Scouting activities there are times when illness or accident may occur and
immediate surgical or medical attention is necessary. This is my permission for the leader in charge, or designate, to make
arrangements for qualified surgical or medical attention for my child/ward in the event of an emergency without necessity
of my prior approval. I understand that I will be notified by the quickest means possible if this authority is exercised.
Residents of Quebec:
Experience has shown that in connection with Scouting activities there are times when illness or accident may occur and
immediate surgical or medical attention is necessary. In the event of an emergency in which my child’s life is in danger or
his/her integrity is threatened, and I cannot be reached to provide consent, I agree that care may be provided to my child
without my consent, as contemplated in paragraph 1 of article 13 of the Civil Code of Quebec. I understand that I will be
notified by the quickest means possible if this authority is exercised.
IF YOU WILL BE ABSENT FROM YOUR NORMAL PLACE OF RESIDENCE DURING THE PERIOD WHEN
THE EVENT IS BEING HELD, PLEASE INDICATE HOW YOU CAN BE CONTACTED:
Name:
Phone:_______________________Cell:_____________________
□
OR
I will attend the event/activity with my child/ward.
Permission to participate:
I the undersigned, having read, understood and completed the above, and having been briefed regarding the
nature of the activity, hereby give my permission for my child/ward to attend and participate in:
□
the following event/activity:
□
at the following location:
□
:
with the following Leader in charge
□
on the following date:
I HAVE REVIEWED THE INFORMATION ON MY CHILD’S/WARD’S PROGRAM PARTICIPANT
ENROLMENT FORM AND CONFIRM THAT THE INFORMATION IS UP TO DATE.
Signed, Parent/Guardian: ______________________________
Date: _________________________
FOR OUT-OF-COUNTRY TRAVEL
Both Parent/Guardian’s Signatures Required for Out-of-Country Travel
Signed, Parent Guardian:________________________________
Date: _________________________
1. Signed before me, _______________________ (name of witness), this _____________________ (date)
by ______________________________ (parent/guardian’s name) at ________________________ (name of location).
Witness Signature: __________________________________________
Signed, Parent Guardian:________________________________
Date: _________________________
2. Signed before me, _______________________ (name of witness), this _____________________ (date)
by ______________________________ (parent/guardian’s name) at ________________________ (name of location).
Witness Signature: ___________________________
B.P.&P., Section 20000
August 2006
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