Application to Attend an Activity or Event as a Non-Member

A9 V20170124

(over 18 years of age) Page one of this form should be retained by the Applicant. Page two should be returned to the Events Administration Officer at [email protected] Activity / Event

Joey Cub 2017

Location

Fremantle

Start Date

02 September 2017

Time

9:00am

Finish Date

02 September 2017

Time

4:00pm

Leader in charge of Activity / Event

Walleroo / Currawong

Appointment

T-JSL / CSL

Email Address

[email protected] / [email protected]

Mobile

+61 417 920 355 / +61 429 709 341

Cost of Activity / Event

$10

Payable to

Group

This Activity / Event

WILL

This Activity / Event

WILL

WILL NOT

✔

include water and swimming activities

This Activity / Event

WILL

WILL NOT

✔

include adventurous activities as listed below

✔

WILL NOT

By the (date)

Invoice

be under direct adult supervision

Adventurous Activities to be undertaken as part of this Activity /Event

Nil

Additional Information Applicant should keep this page for reference and return page 2 to the Events Administration Officer at [email protected] by the time indicated. Additional information may be provided on a separate sheet e.g. maps etc. Please meet at the Claisebrook Train Station by 9:10am. We will be boarding the 9:17am train from Armadale, to arrive in Fremantle by 10:00am. We expect to be returning to Claisebrook Train Station by 3:50pm. Parents will need: - a sun hat (no caps please) - sunscreen - a day pack containing a water bottle, a jacket/jumper, and two pieces of fruit

Payment Methods Please call or email the Events Administration Officer at (08) 6240 7700 or [email protected] to discuss payment options.

SCOUTS WA

133 Scarborough Beach Road, Mount Hawthorn WA 6016 Tel (08) 6240 7700 Email [email protected]

Website: scoutswa.com.au

Application to Attend an Activity or Event as a Non-Member

A9 V20170124

(over 18 years of age) Activity / Event

Joey Cub Day 2017

Start Date

Applicant Details Given Name

Family Name

Date of Birth

Gender

Phone

Mobile

Address

Suburb

Post code

Email

Are you of Aboriginal or Torres Strait Islander origin?

Yes

No

Is English the primary language spoken at home?

Yes

No

02 September 2017

Male

Child Protection Requirements Working with Children Check Card Number, or Application Receipt Number

Female

If required for this event. If unsure please contact the Membership Officer at [email protected] or (08) 6240 7700

Expiry Date

Please confirm you have reviewed and signed the Code of Conduct for Adults in Scouting on page 2 I acknowledge that Scouts WA has a Child Protection Policy which can be found at www.scoutswa.com.au/policies and further acknowledge that a breach of this policy can result in Scouts WA reporting me to the relevant authorities.

Yes

No

Yes

No

Medical Details Event organisers should be advised of the applicant’s health and fitness, including any medication (with instructions) the applicant will bring with them. For special diets, please provide examples (brand names etc.) of what the applicant is able to eat. Attach a separate sheet listing these requirements in detail if required.

Permission to disclose medical information to the application?

Yes

No

Known allergies Dietary requirements Medication (type / name) Dosage Other information (eg. ailments / disabilities) Has the applicant been immunised against Tetanus in the past 5 years?

Yes

No

If not, can the applicant be given a Tetanus injection should the need arise?

Yes

No

Medicare No Private Health Fund Name

Frequency of Dose

Date Immunised

Expiry Date Member Number

Ambulance Cover

Yes

No

Water Activities Authority and Agreement This activity / event may include swimming activities such as swimming in rivers, pools, lakes, water slides and snorkeling. Boating activities may include canoeing, kayaking, rafting, and sailing. If water activities are included as part of this event:

Do you agree to take part in the listed water activities? Are you confident that you can swim a minimum of 50 meters and stay afloat for 3 minutes without the aid of a personal flotation device? Are you confident that you are able to swim 50 meters dressed in shirt, shorts, shoes and a properly fitting personal flotation device and thereafter remain afloat?

Yes

No

Yes

No

Yes

No

Agreement and Scouts WA Liability Statement (Waiver)

Privacy Policy Personal information is collected primarily for the purpose of considering your child’s application for membership to Scouts WA and this information will be treated strictly in accordance with Scouts WA Privacy Policy. A copy of that Privacy Policy may be obtained by visiting our website at www.scoutswa.com.au. At any time upon written request you may gain access to the information Scouts WA holds about you in accordance with the Privacy Act 1988 (Cwth) and the National Privacy Principles. Use of Images By applying for membership it is accepted that photos or video footage of the applicant may be used for promotional purposes and on Scouts WA managed media channels. It is also accepted that it is impossible for Scouts WA to guarantee that photos will not be used on external sites. Medical Authority I further authorise any Member, employee or agent of Scouts WA, in the event of any accident or illness, to obtain medical assistance or treatment for the applicant as may be considered necessary. This includes to engage any doctors’ or nurses’ assistance and to request ambulance transport and/or hospital accommodation. In this event, I agree to pay Scouts WA on demand all such doctors’ fees, nurses’ fees, ambulance fees, hospital fees and other expenses. I give permission for the applicant to attend the Scouting activity, including the listed Adventurous and Water Activities as described in this form and for the Leader in charge of the activity to seek medical assistance for the applicant should the need arise. I have read and agreed to the terms of the Scouts WA Liability Statement (Waiver) located at www.scoutswa.com.au/policies

Signature Applicant

Date

Printed Name

Pages 2 and 3 of this application form should be forwarded to Scouts WA as per the instruction on Page 1

Code of Conduct for Adults in Scouting

1.

Adults in Scouting respect the dignity of themselves and others.

2.

Adults in Scouting demonstrate a high degree of individual responsibility, recognising that at all times their words and actions are an example to other members of the Movement.

3.

Adults in Scouting act at all times in accordance with Scouting Principles, thereby setting a suitable example for all.

4.

Adults in Scouting do not use the Movement to promote their own beliefs, behaviours or practices where these are not compatible with Scouting Principles.

5.

Adults in Scouting act with consideration and good judgement in all interpersonal relationships both inside and outside Scouting.

6.

Adults in Scouting respect everyone’s right to personal privacy at all times. They take special care where sleeping, changing of clothing; bathing and ablutions are associated with any Scouting activity.

7.

Adults in Scouting avoid unaccompanied and unobserved activities with youth members wherever possible.

8.

Adults in Scouting, for their own protection, should avoid potentially compromising situations by ensuring, where reasonably possible, that at least two adults are in attendance whilst supervising and/or accompanying youth members. It is recognised that in certain circumstances, it may be necessary for a Leader or adult, whilst acting responsibly and exercising their Duty of Care, to be alone with a youth member. Adults in Scouting are committed to providing a safe environment for youth members participating in the Scout program, their parents or guardians and visitors.

9.

That safe environment must be in accordance with Scouts Australia’s policy of zero tolerance toward bullying, neglect, emotional, physical or sexual abuse of any kind. Adults in Scouting recognise that abuse can take many forms and can be perpetrated through various mediums, including through technology, and will be alert to abuse in all of its manifestations. Adults in Scouting must report any conduct seen or heard that does not comply with this Code of Conduct. Specifically, Adults in Scouting must report promptly any suspicion or allegation of child abuse of youth members in their care.

10.

Where mandatory reporting is required, incident reports must be made to the Police or designated State/Territory Authority in accordance with State or Territory Law and the nominated Scouting person should be advised. In all other cases the incident must be reported to the nominated Scouting person who shall report any suspicion or allegation of child abuse to the appropriate authority.

I have read, understand and commit to abide by the Code of Conduct for Adults in Scouting and accept that a breach of the Code can affect my standing as a member of Scouts Australia and result in my immediate expulsion from the Activity / Event. Signature Applicant Printed Name

Date