Form: C4

Issue: 6
Date: 1/03
PARENT'S COPY
THE SCOUT ASSOCIATION OF AUSTRALIA
QUEENSLAND BRANCH

NOTIFICATION OF CAMP/OUTDOOR ACTIVITY

Maryborough Combined Venturer Unit
Dear Parent/Guardian,
The following are the arrangements for the next Jet Boat Safety Crew Fundraiser and camp at

PLACE: Susan River Jet Boats

DURATION: 4.09.2010 to 5.09.2010
ASSEMBLY : At Susan River Jet Boat site at 8:00am
RETURN : At Susan River Jet Boat site at 4:00pm
Activity under the control of Adult Leader D. Minnis
COST : $Nil Once this amount is paid and provisions purchased, no refund will be made through non-attendance at
the respective Activity except in special circumstances.

NOTE : Camp kit varies for Hikes, Overnight Canoe Activities etc. Consult your Patrol Leader / Adult Leader.

PARENTS/GUARDIANS Please retain this section for your records

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LEADER'S COPY
THIS FORM TO BE FILLED IN BY PARENT OR GUARDIAN AND RETURNED TOGETHER WITH
CAMP FEE, TO THE LEADER IN CHARGE BY 31.08.2010

I approve of .........................................................................................................................................................
(Scout's Name)

Address ...............................................................................................................................................................
attending camp from ...................am/pm............./.........../.............. to .............am/pm.............../............/...........
Should the necessity arise, I can be contacted at ...............................................................................................
............................................................................................................ Phone ....................................................
I submit the following details for your attention :
Medicare No ............................................................ Ambulance Subscriber ? ...................................................
Is the Scout physically fit ? ................................ Points in the Scout's health requiring some special attention
.............................................................................................................................................................................
Will medication and dosage instructions be carried ? .........................................................................................
If so please supply details....................................................................................................................................
Date of last Tetanus injection..............................................................................................................................
Can the Scout swim ?.......................................... If so, is he/she allowed ? .....................................................

“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 the
Medical Practioner 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 or guardian ................................................................................Date ............./........../..........