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The Scout Association of Australia, Queensland Branch Inc.
Form: C4
Issue: 10
Notification Of Camp / Outdoor Activity
Date: 03/15
Part A
PARENTS COPY
Dear Parent/Guardian, The following are arrangements for the next Troop/Patrol Camp/Hike
Place:
Seeonee
Park Scout Ground
DURATION
From:
To:
11/03/16
13/03/16
ASSEMBLY
Location:
Time
Seeonee Park
From
4pm
RETURN
Location:
Time:
Seeonee Park
10:00am
Activity under control of Adult Leader/Patrol Leader: Daniel Stephens
Cost:
$ 0.00
Once this amount is paid and provisions purchased, no refund will be made through non‐attendance at the respective activity
except in special circumstances.
Part B
LEADERS COPY
This Form To Be Filled In By Parent(S) Or Guardian(S) And Returned, Together With Camp Fee To The Leader‐In‐Charge
By
I approve of
Address:
Seeonee
Park, Yeppoon Rd
Attending camp from: 11/03/26
Should the necessity arise, I can be contacted at:
Phone
(Scouts Name)
to
13/03/16
Mobile
I submit the following details for your attention:
Medicare No.
Date of last Tetanus Injection:
Points in the Scout’s health or behaviour requiring some special attention:
Details of any medication and dosage that will be carried:
The program will contain the indicated adventurous activities requiring specific approval. Initial adjacent to activity
Swimming
Pioneering
Archery
Canoe/Kayak
Bushwalking
4WD
Abseiling
Snorkelling
Rock Climbing
Caving
In the event of injury to the Youth Member, where reasonable attempts to contact me are unsuccessful I give authority for such
medical treatment to be given to the youth member as is recommended by a medical practitioner and seems in the opinion of the
leader in charge to be reasonable and appropriate. I undertake to be responsible for any fees or charges with respect to that
treatment and to pay those costs on demand by the Association.
Signature of parent, caregiver or guardian:
Date:
Signature of parent, caregiver or guardian:
Date:
(If no second signature, please state a reason. for example, single parent)
C4 - Roventure Time.pdf (PDF, 126.91 KB)
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