Camp Information Form

Event Details

Worthing Scouts Overnight upcoming camp, information confirmation and permission form

Unit & Leader to send this form to:*

Camp Details & Date

Location, or name of camp, and the dates your Explorer is attending.

Name and location of camp this form relates to*

Confirm the name, description of the camp your are confirming these details, and giving permission for.

Attending from date*

Date arriving at camp

Attending to date*

Date leaving camp

Young Person Details

Young Person's Name*

First Last

Date of Birth*

Have they been in contact with any infectious diseases within the last 3 weeks?*

Date of last tetanus immunisation*

Medicines currently being taken*

Do they have any allergies to food, medicines or other?*

Do they have any special dietary needs?*

Do they have any additional needs?*

Name, address and telephone number of own doctor*

Primary Contact 1*

Name Relationship to Young Person

Phone*

During the event, I can be contacted in an emergency on

Primary Contact 2*

Name Relationship to Young Person

Phone*

During the event, I can be contacted in an emergency on

If you are going to be away at anytime during this camp, we must have alternative contact details for you, or alternatively another family member or friend who has agreed to be contacted should your Scout or Explorer become unwell.

Alternate contact details if applicable:

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Event Details

Camp Details & Date

Young Person Details

Permissions