Consent forms | Penistone Scouts

Event / Activity Digital Consent form

The following consent and health information must be completed by a suitable adult prior to the activity or event. Details provided will only be used for the event/activity in question, and will be destroyed in a timely fashion afterwards.

General basics
Name of event / activity*
Please choose, from the drop-down list, which event or activity you are providing consent information for.
Young person's name*
First Middle Last
Address*
Street Address Address Line 2 City Postal Code
Date of birth*
Date Format: DD slash MM slash YYYY
Religion (if any)
Emergency Contact Name*
First Last
Emergency Contact Number*
Relationship*
Permission to take part
(To be completed by parent / guardian)
Consenting Adult's Name*
First Last
Date consent given*
Date Format: DD slash MM slash YYYY
Email address*
We will send a copy of this completed consent form, upon submission, to you. Please, therefore, provide an email address for this purpose.
Enter Email Confirm Email
Medical information
(To be completed by parent / guardian)
Doctor's Name
Prefix First Last
Doctor's Address
Street Address Address Line 2 City Postal code
Doctor's Phone Number (daytime)
Doctor's Phone Number (night)
Medical consent*
Should the necessity arise, and I can not be contacted by telephone or any other practical means to authorise urgent medical treatment to the above-named participant, I hereby give my general consent to the leader in charge to authorise the medical authorities to give any necessary medical treatment.
I hereby give consent
Health Information
It is important to complete this as fully as possible
Participation*
Are there known medical/health reasons why the participant should not take part in the event?
Extended details for health impact to participation*
Please use the below area to provide details. If you've clicked YES by accident, change your response to NO to hide this prompt.
Infectious illnesses*
Has the participant been in contact with any infectious illness in the last three weeks?
Extended details for infections*
Please use the below area to provide details. If you've clicked YES by accident, change your response to NO to hide this prompt.
Chronic illnesses*
Does the participant suffer from ASTHMA, HAYFEVER, MIGRAINE, FITS, FAINTS, EPILEPSY, DIABETES, or any other ILLNESS or DISABILITY?
Extended details for chronic illnesses*
Please use the below area to provide details. If you've clicked YES by accident, change your response to NO to hide this prompt.
Allergies*
Is the participant allergic to ANTIBIOTICS, PLASTERS or any other MEDICINES/FOOD?
Extended details for allergies*
Please use the below area to provide details. If you've clicked YES by accident, change your response to NO to hide this prompt.
Dietary*
Does the participant have any SPECIAL or DIETARY needs?
Extended details for dietary needs*
Please use the below area to provide details. If you've clicked YES by accident, change your response to NO to hide this prompt.
Non-prescription medicines*
The following medications will be available if required, please indicate which may be administered to your young person.
- Select All
- Paracetamol tablets 500mg (for adults & children 12+)
- Paracetamol suspension – Calpol (for children 6 – 12 years)
- Savlon – Antiseptic cream
- Throat lozenges
- Paediatric couch linctus (for children 6 – 12 years)
- Anthisan cream (for insect bites/stings)
- Ibuprofen (age appropriate)
Prescription items*
If the young person named above requires additional prescribed medication, I will either print/complete a form and hand it in at check-in or provide details upon arrival.
I agree to provide prescribed medication details as appropriate
The following link can be used to download a copy of the prescribed medical notification form.

PLEASE NOTE: This will open a new window, we recommend you complete the consent form in its entirety and submit it BEFORE you attempt to get a copy of the additional form from the below link.

Click here to download our Word Template form for Prescribed medicines
Phone
This field is for validation purposes and should be left unchanged.

Event / Activity Digital Consent form

General basics

Permission to take part

Medical information

Health Information

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