Form B THE SINGAPORE SCOUT ASSOCIATION

No. 1 Bishan Street 12 Singapore 579808 Tel: (+65) 62592858 Fax: (+65) 62592118 Email: hq@scout.org.sg Website: www.scout.org.sg

Camp Possible: Singapore Cuboree cum 7th Cub Scout

Cuboree Individual Participant Form (For Cub Scout Participants and Staff Under Age 18)
A. Personal Particulars Full Name: NRIC/Passport No.: Nationality: Home: School / Pack : Area: Section B. Medical & Health S/n Please Tick in the appropriate box under Yes or No 1 Have you been in contact with any infectious illness during the last four weeks? If yes, please state illness: 2 Does your health require special care or supervision in any way? If yes, please give details: 3 Please list dietary needs (on religious or medical grounds only). E.g. Vegetarian (Note: All meals are Halal) 4 Are you allergic to any drug/medication? If yes, please give details: North / South / East / West * Cub / Scout / Venture * District: T-Shirt Size: Date of Birth: Sex : Mobile: DD / MM / YYYY Male / Female * Email: Age:

Passport Sized Camporee Photograph In Scout Uniform

Blood Group:

XXS / XS / S / M / L / XL / XXL / XXXL *

Yes

No

If you have answered Yes to Qn 1,2 or 3, please provide details in a separate sheet if you require more space. Please clearly indicate your name on top.

C. Next of Kin In case of emergency, please contact the next of kin:Name: Email: Relationship: Mobile:

_______________________________ Signature of applicant

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______________________ Date
* Delete where inapplicable

Form B THE SINGAPORE SCOUT ASSOCIATION

No. 1 Bishan Street 12 Singapore 579808 Tel: (+65) 62592858 Fax: (+65) 62592118 Email: hq@scout.org.sg Website: www.scout.org.sg

Camp Possible: Singapore Cuboree cum 7th Cub Scout Camporee

D. Parental / Guardian Consent I, ____________________________________________ father / mother / guardian * hereby allow my child / ward * to participate in / volunteer as staff at * the Singapore Cuboree cum 7th Cub Scout Camporee. I fully support and encourage this event. Furthermore, I undertake to accept that no liability will be borne by the Singapore Scout Association and/or the organisers, or the School and/or its teachers for any personal injury or loss sustained by my *child / ward during the camp with the full understanding that all necessary precautions will be taken to ensure the safety of all participants.

_________________________________ Signature of father / mother / guardian * NRIC No:

______________________ Date
* Delete where inapplicable

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