Get Boys Brigade Enrollment Format Pdf

Please return to Officer in Charge not more than seven days before the event NAME IN CAPITALS SPECIAL EVENT / ACTIVITY CONSENT FORM PART A To be completed by The Boys Brigade Company / Battalion / District 195th Glasgow Company Activity or Event Venue PGL Dalguise Activity Centre Dates 24th to 26th May 2013 Officer in Charge Alistair K. McInnes Full name of member Date of birth PERMISSION I give my permission for to attend and take part in the activities or event named in Part A. I understand that in the event of any illness or accident every effort will be made to contact me but if this is not possible I authorise any Officer to sign on my behalf any written form of consent required by medical authorities. MEDICAL DETAILS Name and address of young person s Doctor National Health Service Number Details of any infectious disease with which the young person has been in contact within the last three weeks Details of medicine / diet / treatment which is being taken / followed Details of known allergies / sensitivities e*g* My child has / has not been immunised against tetanus within the last five years. Delete as appropriate ADDRESS ES OF PARENT / GUARDIAN DURING THE EVENT Name PARENT / GUARDIAN Address Telephone day evening Signed Date The Boys Brigade is registered under the Data Protection Acts. The information requested on this form is for Company use only and will not be passed onto anyone else. Any parent may request a copy of relevant information held by the Company and enquiries should be directed to the Company Captain* December 2002. McInnes Full name of member Date of birth PERMISSION I give my permission for to attend and take part in the activities or event named in Part A. I understand that in the event of any illness or accident every effort will be made to contact me but if this is not possible I authorise any Officer to sign on my behalf any written form of consent required by medical authorities. I understand that in the event of any illness or accident every effort will be made to contact me but if this is not possible I authorise any Officer to sign on my behalf any written form of consent required by medical authorities. MEDICAL DETAILS Name and address of young person s Doctor National Health Service Number Details of any infectious disease with which the young person has been in contact within the last three weeks Details of medicine / diet / treatment which is being taken / followed Details of known allergies / sensitivities e*g* My child has / has not been immunised against tetanus within the last five years. MEDICAL DETAILS Name and address of young person s Doctor National Health Service Number Details of any infectious disease with which the young person has been in contact within the last three weeks Details of medicine / diet / treatment which is being taken / followed Details of known allergies / sensitivities e*g* My child has / has not been immunised against tetanus within the last five years. Delete as appropriate ADDRESS ES OF PARENT / GUARDIAN DURING THE EVENT Name PARENT / GUARDIAN Address Telephone day evening Signed Date The Boys Brigade is registered under the Data Protection Acts.