C4 Roventure Time .pdf

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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) 

 


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