E-mail: firstname.lastname@example.org Website: www.scouting.org.za Tel: 0860 SCOUTS
Consent and Indemnity Form
To the Provincial Commissioner, Scouter,
I, (Full names of Parent / Legal Guardian)
Home Telephone Cell Number
being the Parent / Legal Guardian of (minor child’s full name), hereinafter referred to as ‘Ward’,
a member of the Group,
hereby permit him/ her to partake in the activity/camp referred to below
I hereby appoint and authorise the Scouter, Chairman or Commissioner in charge to act in my place as parent/guardian with
full authority to consent to my Ward undergoing surgical and/or medical treatment. I undertake to pay the costs of such
I hereby DO/ DO NOT give permission for my Ward to participate in any water activities.
I fully understand and accept that all activities are undertaken at my Wards own risk.
I am aware that neither SCOUTS South Africa, nor its Chairmen, Commissioners, Scouters, agents, employees, volunteers or
any person associated with SCOUTS South Africa accept responsibility for any loss, injury or damage that the person or
property of my Ward may sustain whilst engaged in any Scouting, including inter-alia transport to and from the activity.
I hereby waive any right that I or my Ward may have to claim compensation against SCOUTS South Africa or its Chairmen,
Commissioners, Scouters, agents, employees, volunteers or other members, in respect of any loss, injury or damage incurred
whilst engaged in any Scouting activity howsoever arising and whether as a result of negligence or otherwise and I indemnify
SCOUTS South Africa against all such claims.
I agree and authorize that photo’s, statements, audio – visual recordings, video and sound bites taken, recorded and
collected from my Ward during activities with SCOUTS South Africa may be used free of charge and at the discretion of
SCOUTS South Africa as part of their marketing, communication and fundraising campaigns.
Signed: __________________________________ Witness: ____________________________________
Dated this _______________________ Day of _________________________________ 20 ______________
Name Doctor Tel No
Medical Aid Scheme
Medical Aid Number
Med Aid Prinicpal Member