6-8 July 2012: District Camp Health Form
You can complete this form whenever you want but please note that you are responsible for notifying us of any changes to your answers between the date that you complete it and the date of the camp
Full name of Cub: *
Your answer
Date of Birth: *
Please use the format DD/MM/YY
Your answer
NHS Number: *
Enter "unknown" if you do not know this
Your answer
Emergency contact name: *
This must be a responsible adult who will not be on the camp and will be available throughout in case of emergency
Your answer
Emergency contact address: *
Your answer
Emergency contact telephone number: *
Your answer
Name of Cub's doctor: *
Your answer
Doctor's phone number: *
Your answer
Date of last tetanus injection: *
Please give an approximate date if you are not sure
Your answer
Details of any medications currently being taken:
Please label these with your Cub's and hand them to the camp leader
Your answer
Details of any mobility difficulties:
Your answer
Details of any allergies:
eg penicillin, aspirin, particular foods
Your answer
Details of any special dietary needs:
eg vegetarian, vegan, lactose intolerance, coeliac
Your answer
Any other information:
eg bed wetting, travel sickness, expected home sickness
Your answer
Do you consent to your Cub sleeping in mixed sex accommodation? *
Please tick all of the following may be administered to your Cub Scout by a first aider to relieve minor ailments during the activity:
Please type your name as confirmation of the statement below: *
I give permission for my Cub to attend the above Camp. If it becomes necessary for my Cub 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 and authorise the Camp Leader (or in their absence one of the assistant Camp Leaders) to sign any document required by the hospital authorities. I will inform the Camp Leader if any of the information given on this form changes before the event takes place or if my Cub has been in contact with any infectious diseases in the three weeks before the Camp.
Your answer
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