FORT HENRY OVERNIGHT PROGRAM
PARENTAL CONSENT FORM

I, the under signed, hereby give parental consent for my child _________________________, a member of 3rd Kanata Scout Group , to participate in the Overnight Program at Fort Henry on September 28-29, 2002 .

SIGNED, Parent/Guardian: ____________________________________________

DATE: ______________________________

MEDICAL INFORMATION FORM

This information is being collected to ensure your child will be as safe as reasonable precautions will allow. This information will remain confidential, and is for internal administrative use only, collected under authority of the Ministry of Tourism and Recreation Act, S. O. 1982, c.7, s.4; Historical Parks Act, R.S.O. 1980, c. 199, s.2.

Please be advised that Fort Henry personnel are not authorized to, and will not administer any medication to participants.

Parent/Guardian's Name ___________________________________________

Participant's Name ________________________________________________

Address ___________________________________________________________________

Phone (H)_______________ (W)_______________ Health Card # _____________________

Doctor's Name _________________________________  Phone # _____________________

Does your child have any allergies? yes ___ no ___

Please specify ______________________________________________________________

Is your child allowed full physical activity? yes ___ no ___

If no, please specify _________________________________________________________

Other comments ____________________________________________________________

__________________________________________________________________________

ALTERNATE EMERGENCY CONTACT:

NAME: ____________________________________

ADDRESS: _________________________________________ PHONE: ________________