ࡱ>  WbjbjT~T~ <66999MMM8Y M *eb  ')))))))))))))$+l.zM)9p p p M))"""p v89')"p ')""%!%>M v%))0 *%,.\!.%.9%4v\T"D|M)M) " *p p p p . : Use of this Form Do not photocopy this form double sided Page 1 is to be retained by the Parent/Guardian, Page 2 to be returned to the Section Leader Parent to retain this page of the form Activity Details Group FORMTEXT 1st MagillSection FORMTEXT SCOUTActivity FORMTEXT Branch HikeActivity Location FORMTEXT Mount Crawford ForestStart Time FORMTEXT TBADate FORMTEXT 10/9/2010Meeting Place FORMTEXT TBA Finish Time FORMTEXT TBADate FORMTEXT 12/9/2010Meeting Place FORMTEXT TBALeader in Charge of Activity FORMTEXT Troy WilliamsAppointment FORMTEXT BCPhone FORMTEXT 0417 851 118Mobile FORMTEXT 0417 851 118Email FORMTEXT abc.scouts-events@sa.scouts.com.au Type of transport to and from Activity FORMTEXT Bus FORMTEXT      Cost of Activity FORMTEXT $75 (Inc bus)Payable to FORMTEXT Martin GregoryBy the FORMTEXT 23/8/2010If you feel that your child is overdue from the activity, you should contactName FORMTEXT Martin GregoryPhone FORMTEXT 0402410971The activityWILL  FORMCHECKBOX WILL NOT  FORMCHECKBOX be under direct adult supervisionThe activityWILL  FORMCHECKBOX WILL NOT  FORMCHECKBOX Involve both male and female youth members The activityWILL  FORMCHECKBOX WILL NOT  FORMCHECKBOX require uniform to be worn Additional Parent Information Parents should keep this page for reference, and return the Authority to Participate Section of this form (Page 2) to the Section Leader by the time indicated  FORMTEXT We will travel by Bus on Friday evening to the event. Time and place of departure TBA FORMTEXT Please bring: FORMTEXT Backpack Torch  FORMTEXT Water bottle Change of shoes FORMTEXT Dilly bag & contents Personal First Aid Kit FORMTEXT Toiletaries Hiking Toilet paper supply FORMTEXT Sleeping bag Movie Theme Costume Materials FORMTEXT Sleeping mat & blanket FORMTEXT Waterproof/windproof coat for hiking FORMTEXT Warm clothes, for day and night, 2 changesReturn this page to the Section Leader Authority to Participate Parents Consent to be returned to the Section Leader by FORMTEXT Friday 20th August 2010Activity FORMTEXT Branch HikeActivity Date FORMTEXT 10-12th September 2010Name of Youth Member FORMTEXT      Date of Birth FORMTEXT      Name of Group / Section FORMTEXT      GenderMALE  FORMCHECKBOX FEMALE  FORMCHECKBOX Address of Youth Member FORMTEXT      Phone FORMTEXT      Suburb FORMTEXT      Postcode FORMTEXT     Email Address FORMTEXT      Health and Fitness aspects of youth member that leaders should be advised of, including any medication, with instructions, the child will be bringing. For special diets please provide examples, brand names etc of what you are able to eat. Attach a separate sheet listing in detail these requirements. FORMTEXT       FORMTEXT      Known allergies FORMTEXT      Dietary requirements FORMTEXT      The following activities will be provided during the event. Please indicate Yes or No to allow your child to participate in the specified event. **If there is no indication your child will not be permitted to participate in that activity**Type of ActivityConsentType of ActivityConsent FORMTEXT HikingYES  FORMCHECKBOX NO  FORMCHECKBOX  FORMTEXT Various Checkpoint ActivitiesYES  FORMCHECKBOX NO  FORMCHECKBOX  FORMTEXT Light Weight CampingYES  FORMCHECKBOX NO  FORMCHECKBOX  FORMTEXT      YES  FORMCHECKBOX NO  FORMCHECKBOX Can he/she swim20m50m100m FORMTEXT      YES  FORMCHECKBOX NO  FORMCHECKBOX During the activity where we can contact the parentsName FORMTEXT      Address FORMTEXT      Phone FORMTEXT      In case of an emergency the contact person will beName FORMTEXT      Address FORMTEXT      Phone FORMTEXT      Relationship to Youth member FORMTEXT      Hospitals sometimes require  ɽygcXyF#jthZ[h&0CJUaJhZ[h6 ACJaJh%?#jhZ[h/;CJUaJhZ[h&0CJaJjhZ[h&0CJUaJhZ[h6 A5CJaJh6 Ah6 A5CJaJhY=G5CJaJhSP5CJaJh%hY5CJaJh%5CJaJhtihtiCJaJhtih%CJaJhEh%CJaJhY=Gh%5CJaJ  $Ifgd%? $IfgdAH ^`gdY=G ^`gd6 A$^`a$gdY7$d%d&d'd-DM NOPQ^`gdkj ^`gd%      % & ' 2 3 5 G H R S T i j l w x ˹˧˕˃q#jhZ[h&0CJUaJ#jEhZ[h&0CJUaJ#jhZ[h&0CJUaJ#jzhZ[h&0CJUaJ#j#hZ[h&0CJUaJhZ[h&0CJaJhZ[h6 A5CJaJhZ[h6 ACJaJjhZ[h&0CJUaJhv,   4 *!! $IfgdAHkd$$Ifls\p*th$   t0+44 l` ap(yt;zF4 5 G k f]] $IfgdAHkd$$Ifls0*t#  t 0+44 l` apyt;zFk l w f]]]]]]X]]Ff $IfgdAHkd$$Ifls0*t#  t 0+44 l` apyt;zF         ! 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$IfgdAHkdY$$Ifl\?'O!*(Y   t0+44 l` ap(yt|VX~ $IfgdAHxkdZ$$IflF*+ t0+44 l` ap ytZ[~uu $IfgdAHkd[$$Ifl*+  t 0+44 l` ap ytZ[(*,8:NPR\^b 468PRfhjtμΕ΃xvxd#jbhZ[h&0CJUaJUhZ[h1CJaJ#j_hZ[h&0CJUaJ#j^hZ[h&0CJUaJ(jhZ[h&0CJUaJmHnHu#j]hZ[h&0CJUaJhZ[h&0CJaJhZ[h15CJaJhZ[h1CJaJjhZ[h&0CJUaJ',8`f]]]] $IfgdAHkd\$$Ifl0?*i&  t 0+44 l` apyt|`b*!! $IfgdAHkd^$$Ifl\?'O!*(Y  t0+44 l` ap(yt|f] $IfgdAHkd?`$$Ifl07 * q  t 0+44 l` apyt|6~ $IfgdAHxkd"a$$IflF*+ t0+44 l` ap ytZ[ the following informationMedicare No FORMTEXT      Ambulance CoverYES  FORMCHECKBOX NO  FORMCHECKBOX Private Health Fund DetailsName FORMTEXT      Member # FORMTEXT      Table FORMTEXT       Agreement and Medical Authority Medical I agree not to make a claim against Scouts Australia (SA Branch) beyond the level of insurance provided by their policies (see explanation below). I authorise any member or other official representative of Scouts Australia (SA Branch) to obtain any medical or dental attention or treatment, or ambulance assistance, considered necessary (or expedient) for the applicant. I agree to reimburse Scouts Australia (SA Branch) for any expenses incurred as a result which are not covered by the Associations insurance policies. Explanation of Scout Association Insurance Scouts Australia (SA Branch) maintains insurance policies designed to cover Adult/Youth Members during Scouting service. For further information you should consult with your Group Leader or relevant Commissioner to ascertain the exact level of cover of these policies. Consent to Use of Image I consent to photographic / video images of me / my child being taken at Scout activities and being used for promotional purposes by and for Scouts Australia. Signed Date Relationship to child [eg parent/guardian/care giver]     Parent AdviceY4 June 2010 Scouts Australia 211 Glen Osmond Road, Frewville SA 5063, PO Box 25, Fullarton SA 5063 South Australian Branch Telephone: (08) 8130 6000 Facsimile: (08) 8130 6010 Email: hq@sa.scouts.com.au 68Px~uuuii $$Ifa$gdz $IfgdAHkda$$Ifl*+  t 0+44 l` ap ytZ[tvx24HJLVX\npѶѧ~i^L#jfhZ[h&0CJUaJhZ[h!CJaJ(jhZ[h&0CJUaJmHnHu#j?ehZ[h&0CJUaJhZ[h&0CJaJhZ[h!5CJaJj~chVFCJUaJj chVFCJUaJjhVFCJUaJhVFCJaJhZ[h15CJaJhZ[h1CJaJjhZ[h&0CJUaJkdc$$Iflr/O!%*  t0+44 l` ap2yt|(2Z\n?kde$$IflF7 _* (I  t0+    44 l` apyt| $IfgdAH Hܺќ|qe\PE:\h|h1CJ aJhF7h1CJaJhph15CJaJh15CJaJhph15CJaJhph1CJaJh\sh1CJaJh15CJaJh\sh15CJaJh|(h15CJ aJ#j6ghZ[h&0CJUaJhZ[h&0CJaJhZ[h!5CJaJhZ[h!CJaJjhZ[h&0CJUaJ(jhZ[h&0CJUaJmHnHu!kdg$$Ifl\7 H!*  y`   t0+44 l` ap(yt| $IfgdAH HIVWop$,  )$d%d&d'dNOPQgdnK<&$d%d&d'dNOPQgdnK<gd1`gd1 ^`gd1HIVWop$%\]^`acdfgijky|辳蠕~~~~vrfXhZ[hM5CJ<^JaJ<hZ[hM5CJ(aJ(hMjhhMUhjhUh-h1CJaJhph1CJ aJ h1CJaJhF7h1CJaJhF7h1CJaJhF7h|(CJaJh15CJaJh|h1CJ aJhF7hW yCJaJhF7h1CJaJhph15CJaJ$%]_`bcefhiky|} $$Ifa$gd|~ $$Ifa$gdZ[* )$d%d&d'dNOPQgdnK<&$d%d&d'dNOPQgdnK<|}>QRSTUVWۼ۸h-h1CJaJhI#hhIhMCJaJh|(CJaJhMCJaJhMhti5CJ^Jh\5CJ^JhZ[hM5CJ ^JaJ CA?kdX}$$Ifl(F"*   t06    44 l` apytZ[RSTUVW* )$d%d&d'dNOPQgdnK<0 !*$d%d&d'dNOPQ]gdI:&P 1h/R :pY. 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