Microsoft word - youth application form 18th nz jamboree 2007-8.doc

YOUTH MEMBER

Revised 30 Jan 2007
APPLICATION TO JOIN
THE AUSTRALIAN CONTINGENT
International Office
– Scouts Australia
18TH NEW ZEALAND JAMBOREE
Canterbury Agricultural Park, Christchurch
28th December 2007 – 05 January 2008
APPLICATION:
I wish to participate in the abovementioned activity as part of the Australian Contingent. If I am accepted, I undertake to
abide by the requirements of The Scout Association of Australia and the procedures laid down by it, and to loyally carry out
the requirements of the Nationally appointed Contingent Leader or his/her nominated deputies.
I have signed the Form of Indemnity on this application, and I agree to be bound by the terms and conditions therein.
Applicant to complete:
PERSONAL DETAILS:
Telephones Home ( ) . Work ( ) . Mobile . Troop/Unit.Group.
Youth members only: I hold the . award. I have camped for . nights.
Previous Jamboree experience (List on paper if required):
.……………………………………
Nationality. Passport Number: .
National HQ to complete
Youth Member Application to Join The Australian Contingent HEALTH STATEMENT:
The Applicant must be currently immunised against tetanus and poliomyelitis at the time of the Event. If the Applicant
suffers from any of the following ailments or conditions, please indicate by placing a tick in the appropriate square, so that
provision can be made for the Applicant's welfare.
General:
Allergies:
…………………………………… …………………………………… …………………………………… …………………………………… …………………………………. Year of last tetanus injection
Details of a history of any serious illness . Are you currently or recently have been under Medical attention? (Specify) . Details of Medical Condition(s) that the Contingent Doctor / Director of Health and Welfare should be aware of: . Details of Medication(s) taken on a regular basis:.    Line Number  Private Medical Health Fund Name. Membership Number. Youth Member Application to Join The Australian Contingent
Emergency contacts: Two persons who can be contacted in case of emergency during the period away
from Australia. (Please indicate address and phone number applicable at the time). To be confirmed
prior to departure.
Name. Name.
Address. Address.
. .
Home Phone ( ) . Home Phone ( ) .
Work Phone ( ) . Work Phone ( ) .
Relationship to Applicant. Relationship to Applicant.

WATER ACTIVITIES AUTHORITY:
Swimming activities at the Event may include (subject to availability) swimming in rivers, dams, pools, beaches, water
slides and scuba diving. Boating activities at the event may include (subject to availability) canoeing, kayaking, rafting,
sailing, wind surfing and water skiing.
ƒ Do you agree to the Applicant taking part in swimming activities planned for the event?
ƒ Are you confident that the applicant is able to swim a minimum of 50 metres and is able to stay afloat for three minutes without the aid of a personal flotation device? ƒ Do you agree to the Applicant taking part in the boating activities planned for the Jamboree? ƒ Are you confident that the Applicant is able to swim 50 metres dressed in shirt, shorts, shoes and a properly fitting personal flotation device and thereafter remain afloat for one (1) minute?
AIR ACTIVITIES AUTHORITY:
I agree to the applicant taking part in any of the optional Air Activities at the Event which may include
Flying in a light aircraft (Scouts only) and gliding (leaders only).
I agree to the Applicant taking part in the air activities planned as an optional extra for the event?

Please Note: The above Water and Air Activities sections must be completed by the same parent(s) /
guardian(s) who sign their name(s )at the completion of this Application Form at the end of the Indemnity-
Authority Statement.
Contingent HQ to complete
Recommendation

To be filled in by the Group Leader:

I _________________________________ recommend this youth member to join the Australian Contingent,
knowing that he/she is a current member in good standing with the Association.

All applications must be accompanied by a deposit of $400.00 - Cheque or money orders payable to Scouts
Australia – 18th New Zealand Jamboree.
Mail to Australian Contingent - 18th NZ Jamboree, International Office - Scouts Australia, PO Box 730,
HEATHMONT VIC 3135 (To ensure that you are a member of the contingent, send before April 30th 2007)
Youth Member Application to Join The Australian Contingent INDEMNITY AND AUTHORITY:
To be completed by Applicant and also by parent(s) or guardian(s) (both if possible) if Applicant is under adult age.
INDEMNITY AND AUTHORITY
In consideration of such of The Scout Association of Australia and the Branches of The Scout Association of Australia as
hereafter do so accepting (applicant name:) .
(Hereinafter called "the participant") as a participant in the abovementioned Scouting Event, and/or treating him/her as a
participant therein and in consideration of such of the members officers servants and agents of any of the said Association
or Branches as hereafter do so treating the participant as a participant in the said event and/or assisting in the said event
and/or assisting in the extension to the participant of facilities arranged for participants therein, whether at the event itself or
elsewhere. I DO HEREBY AGREE TO INDEMNIFY AND KEEP INDEMNIFIED each of such Associations and
Branches and each of such members officers servants and agents from and against all actions, suits, proceedings claims
demands costs expenses and liability whatsoever by or to or in respect of the participant or his/her dependants (whether
arising from the negligence of any such Association, Branches, members, officers, servants or agents or howsoever arising)
in any injury whatsoever attributable to arising out of or connected with his/her participation in the said event or arising out
of or connected with any occurrence during the period from the participant's departure from his/her home or place of
residence (whether temporary or permanent) to attend the said event until his/her return to his/her home or place of
residence after concluding his/her participation in the said event, PROVIDED ALWAYS that this Indemnity shall not in
respect of any particular action suit proceeding claim demand cost expenses or liability extend to any such Association
Branch member officer servant and agent which or who is liable in such action suite or proceeding or is liable to such claim
or demand or is liable for such cost or expense or is accountable for such liability and which or who is entitled to an
indemnity under any contra of insurance in respect of such liability or accountability except to the extent of which it or he is
not indemnified against such liability or accountability under such contract of insurance. During the period from the
participant’s departure from his/her home or place of residence (whether temporary or permanent) to attend the said event
until his/her return to his/her home or place of residence after concluding his/her participation in the said event and at any
time and from time to time during such period I authorise each of the said Association, Branches, members, officers,
servants and agents to obtain such medical and dental assistance and treatment for the participant as it or he shall deem
proper or desirable and for such purpose to engage any medical or dental practitioner nursing assistance or hospital
accommodation and to purchase for the participant such medical and pharmaceutical supplies as it or he shall deem proper
or desirable and I agree to pay all consequent medical dental nursing and hospital fees and expenses and all bills for such
supplies other than fees expenses and bills recoverable under any policy of insurance. Such fees and bills shall at the option
of such Association Branches member officer servant or agent be payable by me to it or him direct to whosoever is entitled
thereto. Further I hereby direct expressly authorise each of the said Association Branches members officers servants and
agents to authorise any medical or dental practitioner engaged in pursuance of the foregoing authority to give or cause to be
given to the participant such medical or dental treatment including surgery as it or he may in its or his sole and unfettered
discretion deem proper or desirable.
Signature of Applicant …………………………………………………….
………………………………………………………………………………………………………………………………….
Signature of parent/guardian (Where possible BOTH parents/guardians are to sign Date …………………………………
Youth Applicant to
I agree to abide by the Scout Promise and understand and agree that the Scout Law is the Code firstly read and
of Conduct and Ethics for this Contingent. I agree to accept the conditions and requirements understand, then print
as set by the Contingent Council and be a worthy and loyal ambassador for both Scouts their full name, sign and
Australia and Australia in general. I understand and agree that drugs and alcohol and any date this section.
other illegal activity as decreed by Scouts Australia and also by Australian and overseas Law Date: ……………….
Name: (print)……………………………………………………………………………………
Signature: ……………………………………………………………………………………….
Payment method  Cheque  Money order  Credit Card
(If paying by Credit Card please complete the following)  MasterCard  Visa

Card Number     Expiry Date / Name on Credit Card . AUD$ .

Source: http://www.scouts.com.au/images/upload/base/11802990.pdf