Medical & Permission Form

The following form must only be completed by a responsible adult – either parents/guardians of participating young people or participating adults only.

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This field is for validation purposes and should be left unchanged.
Section & Event Details
Section*
YOUNG LEADERS: Please select the section your YL will be travelling with (i.e. if they are travelling to an event with the Beaver, Cub or Scout Section that they work with, please select that section and NOT their Explorer Unit).
Event*
Date From*
DD slash MM slash YYYY
Date To*
DD slash MM slash YYYY
Participant Details
Participant Name*
Participant Membership Status*
- Under 18
- 18+
Participant Date of Birth*
DD slash MM slash YYYY
Participant Address*
Participant Address Address Line 2 City County Postcode
Emergency Contact Details
Emergency Contact Name*
Emergency Contact Phone*
Emergency Contact Mobile*
Emergency Contact email*
Medical & Additional Needs Details
Doctor's Name*
Doctor's Address*
Doctor's Address Address Line 2 City County Post Code
Doctor's Phone*
Dietary needs and food allergies*
Enter N/A if not applicable.
Other allergies, medical conditions & physical restrictions*
Enter N/A if not applicable.
Current medication and any other useful medical information*
Enter N/A if not applicable. Please provide as much useful detail as possible.
Other helpful details
So far as possible, we will take these things into consideration when planning the event, but please note that this is not always possible - we will do our best.
Favoured foods
Strongly disliked foods
Any other helpful information
Consent
Photographs (see detail below)*
- Agree
- Disagree (Enter detail below)
Photographs taken during events may be used within a Scouting context and in particular publicity material for example Scouting publications and the media.
Photo Permission Detail
Please detail specific photo permission objections below.
Removal from event (see detail below)*
- Agree
I understand that the event leader will always act to ensure the enjoyment and safety of everyone and therefore reserves the right to send any participant home at any stage. I understand that I will need to collect or arrange appropriate collection of the participant, at my own expense, should that occur.
Medical treatment (see detail below)*
- Agree
If it becomes necessary for my young person to receive medical treatment, and I cannot be contacted by telephone or any other means to authorise this, I give my general consent to necessary medical treatment and authorise a member of the Event Team to sign documents required by hospital staff on my behalf.
Swim 50m unaided (see detail below)
- Yes
For all water based events all participants must be able to swim 50m in light clothing.
Data Privacy (see detail below)*
- Agree
I consent to the personal information contained in this form relating to myself and/or my child to be used for the purposes of administering the event. We will not use this data for any other purpose, except in anonymised aggregate form to provide statistics for historical reference. We will securely destroy this form after the event and we will delete this data one year after the event ends, unless you are or your son/daughter is involved in a medical incident at the event.
Data accuracy (see detail below)*
- Agree
I agree to inform the event leader if any of the information on this form changes before the event takes place.
Name*
This should be the name of the parent or guardian of participants aged under 18.
Relationship to young person*
Enter N/A if 18+ participant.
Email*
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Medical & Permission Form

Medical & Permission Form

Section & Event Details

Participant Details

Emergency Contact Details

Medical & Additional Needs Details

Other helpful details

Consent

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Dwayne Fields proudly holds the title of the UK's 11th Chief Scout