Applicant Information Section

Murum Annual Weeklong Camp 2018,

Activity L-M002

Location: Canobolas Scout Camp near Orange in the The Golden West Region.

Coordinator: Darren Smith, email:, Mobile 0488 012 836

Times: Camp arrivals start at 1000 hours on Sunday the 30th of September, 2018. Camp Closes at 1100 hours on Sunday the 7th of October, 2018.

Cost: Youth = $275.00, Adults = $150.00, Payable by Direct Deposit only to NSW Lones Scout Group. Bank Details will be on the Invoice

Transport: Transport to and from camp will be by parents. If public transport is used, such as Rail, please ensure the ticketing details are sent through to the Activity Coordinator.

Closing Date: Applications Close on the 1st of September, 2018

Name of Group:*
Membership Number:*
Cub Boomerang:*
Scout Cord Level*
Given Names:*
Prefered Name:
Prefered Phone:*
Mobile Phone:
Parents E-mail:*
Date of Birth:*
Adult Help:*
Section Trained:*
In Case of Emergency Contact:*
Emergency Phone:*
Emergency Address:*
Any Disabilities:*
Disabilities - Please Explain:*
Are there ANY known Allergies:*
Allergies - Please be specific:*
Are there any special Food requirements (medical or religious):*
Explain special food requirements:*
If Epilepsy is Yes:*
If Yes to Diabetes:*
If Yes to Asthma:*
Any Medication:*
Medication administered by:*
Medicare Number:*
Date of last Tetanus Injection if known:
Other Medical
Doctors Name:*
Doctors Phone:*
Parents Consent:*
Can the participant swim 50 meters:*
I consent to my childs participation in the following which may be part of this activity:*

I/We acknowledge that this activity will involve inherent and obvious risks. I/We authorise any officer, member, servant or agent 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 participant, 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).

Do you accept and agree to the above medical and acknowledgement statement:*
Name of Participant:*
Signature of Participant:
Parent or Guardian Name:*
Parent or Guardian Signature if under 18 years:
E-mail for Accounts:*

Dress Code for Camp: No short shorts, singlet and low cut tops, or any other "suggestive" clothing is to be worn at this camp. If worn, the wearer will be asked to change or cover up. This protects both your children and the Adults.

Do you accept the Dress Code as explained above: *
Unit Management: *
Environment: *
Youth Helper: *
Initiative: *
The NSW Scouts Air Wing are considering attending the Camp on Saturday the 6th of October to offer flying experience for the youth members. Is this something you would consider supporting? It would be an added expense expected to be around $90.00 depending upon numbers:*
Word Verification: