6th Whitley Bay Scout Group

Medical and Photograph Confirmation Form

Dear Parent(s)

As its time for your son or daughter to move in a new section, it’s also the perfect opportunity for us to refresh our medical consent and personal details.

In order to ensure we are only holding accurate records, which is a requirement under the data protection act, we would like you to take a few minutes and complete the form overleaf as fully as possible.

I appreciate that you may have completed this form in the past, but by doing this now, it allows me to be confident that the information we have is as accurate as possible.

Once you have completed the form overleaf please return it to me ASAP via your section leader. All information will be held in confidence.

If you need any further information or would like to discuss any information on the forms, please feel free to contact me on 07866 432052.

Many thanks

Yours in Scouting

Scott Blackett

Scott Blackett

Group Scout Leader

6th Whitley Bay Scout Group

Tel. 07866 432052

E-mail:

Section 1 – About the Beaver/Cub/Scout/Young Leader/Adult Leader/Helper

Full Name
Home Address
Postcode
Telephone (Home) / Mobile
Email Address
Name of School
Parents Name(s)

Section 2 – Medical Information

Doctors Name
Practice Address
NHS No. (if known)

Does your son/daughter have any medical condition(s) or allergies?YES / NO *

Please provide any details below (E.g. Hayfever, Asthma, Food Allergies, etc.)

Any other medical information and/or dietary requirements?YES / NO *

Please provide any details below

When did your son/daughter have their last tetanus injection? ……………………….………………………………

I do / do not* give permission for my son/daughter to be given paracetamol if considered advisable by a warranted leader or first aider.

I do / do not* give permission for a warranted leader to sign on my behalf, any medical form for my son/daughter if there is a delay in obtaining my own signature and it is deemed necessary.

Section 3 – Photographs

I do / do not* give permission for my son/daughter to be photographed during scouting activities. I am aware than any photograph taken will be used for scouting purposes only and will not be disclosed or provided to any unauthorised person.

Signed: ______(Parent / Guardian)

Date: ______/ ______/ ______

(* delete as appropriate)