THE SCOUT ASSOCIATION OF
NEW
GREATER
APPLICATION TO PARTICIPATE IN A
FLYING FOX
COURSE
INSTRUCTIONS
Print details on this form, attach payment for the Flying
Fox course fee in which you wish to participate and send it 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 and cheque must be
received at Region HQ at least by the closing date of the course to prevent
course cancellation.
COURSE DETAILS
Course Name: Flying Fox Course
Course Date/s:
Course Location:
Qualification to be obtained Assistant Basic
Guide Advanced Guide
(Tick appropriate qualification)
Supervisor
Instructor
PERSONAL
DETAILS Membership
No:
Mr/Mrs/Miss/Ms
.
Given Names
..
..
Postal Address
..
..
. Postcode
Telephone: Home
( )
...
. Business (
)
.
Date of Birth
..
.. Age
..Years
SCOUTING
DETAILS
Rank
. Group
.
District
.. Region
...
PRE COURSE
QUALIFICATIONS
(Leader/Instructor
level only)
List any existing Fox, Rock or
construction qualifications currently held and date they were attained.
Please complete the reverse side of this
form and enclose required fee with and form.
CONSENT FORM (to be completed by Parent/Rover/Leader)
Name
of Participant
..
Name
of Group/Unit/Crew
..
.
Address
of participant
...
.
..
Postcode
.
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/we acknowledge that this activity, by its
very nature, will involve inherent and obvious risks. I/we authorize any officer, member or servant
of The Scout Association of Australia, New South Wales Branch, in the event of
any accident or illness to obtain such urgent medical assistance or treatment
for the above named youth member, including the administration of any anaesthetic or blood transfusion as he or she may consider
expedient and for this 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, dentists, nurses, ambulance and hospital fees (other than
fees and expenses recoverable by the said Association 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 FLYING FOX COURSE (INSTRUCTOR USE ONLY)
Qualification Obtained (Initial) Assistant
.
Basic Guide
. Advance Guide
.
Supervisor
.
Instructor
.
Course
Leader
.Date
.