33rd Oxford (Kidlington) Sea Scout Troop RN102 - Information & Permission Form
General Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
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DD
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YYYY
Religion (or None) *
Your answer
Contact Details
Details provided here will be used as emergency contact details.
Parent/Carer A First Name *
Your answer
Parent/Carer A Last Name *
Your answer
Parent/Carer A Mobile Number *
Your answer
Parent/Carer A Email Address *
Your answer
Parent/Carer B First Name
Your answer
Parent/Carer B Last Name
Your answer
Parent/Carer B Mobile Number
Your answer
Parent/Carer B Email Address
Your answer
Address Line 1 *
Your answer
Address Line 2 *
Your answer
Address Line 3
Your answer
Address Postcode *
Your answer
Home Telephone Number *
Your answer
Medical Information
Doctors Name(s) *
Your answer
Surgery Address Line 1 *
Your answer
Surgery Address Line 2 *
Your answer
Surgery Address Line 3
Your answer
Surgery Address Postcode *
Your answer
Surgery Telephone Number *
Your answer
Dietary Requirements *
(Please list any dietary requirements or allergies, example vegetarian, nut allergy etc)
Your answer
Medical conditions/ Special Needs *
(Please list anything we need to be aware of)
Your answer
NHS Number *
Your answer
Medical Consent
Scout Leaders with a first aid qualification or first aiders may administer the appropriate minor treatment/precautions (as listed below) if required. The following medications will be available at the event / activity, please can you confirm whether it is appropriate against each item.

(Please tick the boxes to confirm permissions)
Calpol 6+ Fastmelts *
Liquid Piriton *
Medical Consent declaration *
If it becomes necessary for the above named young person to receive medical treatment and I cannot be contacted by telephone or any other means to authorise this, I hereby give my general consent to any necessary medical treatment required by my Son / Daughter. I understand that under the terms of The Children’s Act 1986, that a Parent or legal Guardian does not have the right to delegate responsibility for a child’s health. I will inform the Scout Leader if any of the information given on this form should change.
Permissions
(Please tick the boxes to confirm permissions)
Water Activities *
Can the above named young person swim 50 metres unaided?
Photography *
I give consent for photos/videos of my child to be taken, stored and shared internally in the meeting location, local press, Scout websites and social media. I understand that if I later withdraw consent, previously published photos will not be able to be removed. (Regardless of this consent, the group/unit is not responsible for photos taken by other parties.)
Sensitive Information *
I give consent for the storage and processing of this sensitive personal information, including medical details (these are required for the safety of your child). I understand these may be shared with other Scout sections / groups/ if/when my child moves on from the troop or attends National, County or District events.
Additional Information
Is there any other information that we need to know?
Your answer
Confirmation
Please type your name as confirmation of the information provided on this form *
Your answer
Relationship to the above named young person *
Your answer
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