CALEDONIAN RALLY 16th - 18th October 2015 PARTICIPANT APPLICATION FORM Complete ALL white boxes Section A - Personal Details Surname First Name Full Home Address including postcode D.O.B. Phone Number Email Address - please print Full Unit Name Membership Number Date Joined Scouting/Guiding Section B - Medical Details Doctor's Name and Address Can Participant be given paracetamol by first aid staff Phone Number YES/NO Date of last Tetanus Any medical conditions, medicines or allergies - if none please state NONE KNOWN Section C - Emergency Contact details during the event Name Relationship to participant Phone Number Alternative Phone No. And Name Full Address If it becomes necessary for my child 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 a camp leader to sign any document required by the hospital authorities on my behalf. Note: The medical profession takes the view that the parent’s/carer’s consent to medical treatment cannot be delegated. This view is explicit in the Children (Scotland) Act 2003, thus medical consent forms have no legal status and a doctor or nurse insisting on the consent of a parent/carer to a particular treatment has the right to do so. For this reason, we do not insist on parents/carers signing the statement above; however it can be a comfort to medical staff to have general consent in advance from parents/carers or to have a leader on hand able to sign forms required by medical authorities. Signed Relationship to Participant This form has two pages - both pages must be fully completed before it can be processed by the Cally Rally Team Incomplete forms will not be processed and will be returned - this may reduce the possibility of you being allocated to the activity group of your choice. Surname First Name Unit Section D - Activity Choices 1 Decide which Activity Group you would most like to be in: Give the letters of your first Five Activity Group Choices Activity Groups will be allocated on a first come first served basis after the closing date for applications You MUST have parental permission for the Activities included in the Activity Groups you select. 2 3 4 5 Office Use Only Section E - Permissions I understand and accept that some activities are hazardous and that occasionally accidents of varying severity can occur. I will inform the organisers should the participant come into contact with any infectious disease within three weeks of the event I will inform the organisers of any medicine/ diet to be taken during the event and ensure additional supply is brought as appropriate I have no objection to the information on this form being held on computer solely for Rally purposes I have no objection to photographs of the participant being used for publicity (no names will be used) YES/NO Can the Participant Swim 50 metres The participant may take part in the following activities Aerial Runway YES/NO Climbing Wall YES/NO Archery Clay Pigeon Shooting YES/NO Watersports YES/NO Crate Building 4x4 off road driving YES/NO Water Inflatables YES/NO Cruisers YES/NO Assault Course Projectiles YES/NO YES/NO YES/NO YES/NO I confirm the above details to be correct, to the best of my knowledge We regret that we are unable to give refunds, except in exceptional circumstances, for cancellations received less than 28 days before the start of the camp. Cancellations must be in writing. Signed Relationship to Participant I, being the parent/guardian of the young person named above, declare that they are not subject to restrictions by virtue of Section 21 of the Firearms Act 1968 (which applies to persons who have been sentenced to a term of imprisonment or youth custody) and give permission for them to take part in clay pigeon shooting. Signed Name Date This form has two pages - both pages must fully completed before it can be processed by the Cally Rally Team. Incomplete forms will not be processed and will be returned - this may reduce the possibility of you being allocated to the activity group of your choice. Completed Participant Forms must be sent with "Group Application Form" by Unit Leaders Cally Rally Team, Highlands & Islands Regional Scout Council - Scottish Charity: SC039358 4:2015