THE SCOUT ASSOCIATION OF
NEW
APPLICATION
TO PARTICIPATE IN A
Print details on
this form, attach payment for the full fee for the Rockcraft course in which you
wish to participate and send it directly to Greater Western Sydney Region, 6
Your application
and cheque must be received at Region HQ at least two weeks prior to the course
to prevent course cancellation.
(Abseiling,
Rockclimbing, Caving, Canyoning, Recovery, Scout Proficiency)
PERSONAL DETAILS Membership
No:
SURNAME
Given
.
Postal
Address
..
..Post Code
Telephone:
Home:
email:
.
Date
of Birth
..Age
..Years
SCOUTING
DETAILS
Rank
.Group
.
District
..Region
...
Scout
Leaders Consent to Abseil Course
PRE
COURSE QUALIFICATIONS
(Leader/Instructor level only)
List Rockcraft qualifications currently held and date
they were attained including Scout Proficiency Badge (SL to verify):
Please complete the reverse side of this form and
enclose required fee with form.
CONSENT FORM (to be completed by Parent/Rover/Leader)
Name of Participant
Name of Group/Unit/Crew .
Address of participant
Post Code .
Date of birth Age years .Can she/he swim .
ANY MEDIACAL OR FITNESS CONDITIONS ..
ANY CURRENT MEDICATION
Medicare No Other Health Fund .
In case of emergency, contact .Phone ..
I consent to .attending the
Activity from to ...
I understand that, while every care will be exercised by those in charge of this activity, I agree to and do hereby indemnify the Scout Association of Australia New South Wales Branch, its officers, members, servants and agents insofar as to the extent to which the said Branch its officers, members, servants and agents are not entitled to be indemnified under any policy of insurance, from and against all actions, suit, damages, claims and demands arising out of any accident, injury, illness, which may befall or occur to the said applicant during or as a result of participation in any activity or function connected with the said Branch or the Scout Movement in New South Wales or when travelling to or from such activity or function or arising out of death of the said applicant during or as a result of participation in any activity or function connected with the said Branch or Scout Movement in New South Wales or when travelling to and from such activity. I further authorise any officer, member, servant of the said Branch in the event of such accident or illness to obtain such medical assistance or treatment for the said applicant as he or she may consider necessary and for the purpose engage any doctors, nursing assistance or hospital accommodation and in the event I agree to pay the said Branch on demand all such doctors, nurses and hospital fees and expenses (other than fees and expenses recoverable by the said Branch under any policy of insurance)
Signed ..Date
PRE COURSE ADMINSITRATION (OFFICE USE ONLY)
Application Received
..Eligibility
checked
Course Fee Received $
..Receipt
No
.
Acceptance Sent
.Entered on
Roll
SATISFACTORY COMPLETION OF ROCKCRAFT COURSE.
Course
Leader
.Date
.