THE SCOUT ASSOCIATION OF AUSTRALIA

NEW SOUTH WALES

GREATER WESTERN SYDNEY REGION

APPLICATION TO PARTICIPATE IN A

FIRST AID COURSE

Print details on this form, attach payment for the full amount for the First Aid Course in which you wish to participate and send directly to Greater Western Sydney Region 6 Baden Powell Place Winston Hills 2153. Make your cheque payable to ‘THE SCOUT ASSOCIATION OF AUSTRALIA – NSW’ Your application must be received at Region headquarters two week prior to the course.

COURSE DETAILS

COURSE NAME DATES

COURSE LOCATION

Qualification to be obtained Preliminary (under 15 years)

(Tick appropriate qualification) Senior (15 and over)

PERSONAL DETAILS Membership No;

Mr/Mrs/Miss/Ms

Given Name

Address

PostCode

email _

Telephone Date of Birth Age

SCOUTING DETAILS

Appointment

Group

District Region

CONSENT FORM (To be completed by Parents/Rovers/Leaders)

Name of Participant……………………………………………………………………

Group/Unit/Crew……………………………………………………………………….

Address of Participant……………………………………………………………….

………………………………………………………Post Code….……………………

Medicare No…………………………Other Health Fund………………………....

In case of emergency, contact………………………………Phone…………….

I consent to his/her participation in this First Aid Activity

I authorise and officer, member or servant of the Scout Association of Australia – NSW, in the event of any accident or illness to obtain such urgent medical assistance or treatment of the above named youth member, including the administration of any anaesthetic or blood transfusion as he/she many consider expedient and for the purpose to engage any first aiders ambulance officers, doctors, dentists, nursing assistance or hospital accommodation and in this event I agree to pay the said Association on demand all such doctors’, nurses’, ambulance and hospital fees (other than those recoverable by the said Association under any policy of insurance).

SIGNED…………………………………………………………….DATED……………………………….

PRE COURSE ADMINISTRATION (Office use only)

Application Received…………………………………..Eligibility checked……………………………….

Course Fee Received…………………………………..Receipt No……………………………………..

Acceptance Sent…………………………………………Entered on Roll………………………………..