ACTIVITY CONSENT FORM AND GEAR LIST

Dear Parent/Caregiver, we need your approval for young people to attend this activity.

If you approve, please complete, sign and return the lower half of this form.

​
Scout Group: Keas Scouts Rovers
Northdown Te Rangi Cubs Venturers Associates
Sections involved:
Activity Description: Wanaka trip & Tramp
Planned numbers attending: 7+2

Location of the activity: Wanaka & Matukituki valley

Cost of the activity: $

Departure date: 25/1/21

Departure time: 0800
Departing from: Timaru

Walking Bus Rail Canoe Boat

Transport will be by:
Cycling Car Ferry Aircraft

Return date: 29/1/21

Return time: 16:00
Returning to: Timaru

Parents are welcome to visit on:

between the hours of:
​and
I accept responsibility for and will be leading this activity. Activity Leader’s Name: J Johnston & A Bentley

My address is:
Home phone: 87 Coonoor Road Timaru
Work phone: 6889742
Cell phone: 17
Age if under 18yrs:

The contact person during the activity Joanne Wilson

will be: (note: this person is not doing the activity)
Phone: 0274 836 250 ​or
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Items marked with an X are required information.

To the Leader in Charge of the: 2021 Wanaka trip

I give approval for: X

To attend the activity from: Date: to ​

(dd/mm/yyyy)

Under the leadership of: J Johnston & A Bentley

I agree that responsibility for safety is a three way partnership between the participants, parents or caregivers, and those in charge.
The young person named will be amenable to the instructions given by the Activity Leader(s).

X Phone 1:()
During the activity
I can be contacted on:
X Phone 2:()

X Medication must be continued during the activity Yes No

X Special assistance may be required due to a disability Yes No
Please be aware that: X There are special food or other requirements Yes No
Please list any special requirements over the page

Our family doctor’s contact info: X ​Phone: ()

I agree that photographs taken during the course of the Event are the property of SCOUTS
Photographic consent:
New Zealand and may be used in publicity material.

Parent/Caregiver’s signature: X ……………………………………………… Date: ……./……./…….

​Need: Tick this column for items needed for Packed Tick the Packed Need: Tick this column for items needed Packed
this activity. column when it is put for this activity.
in the pack.

Pack/kit bag Mess Bag (to contain & keep clean …)

Water Bottle Unbreakable Mug & Plates
Day pack Knife, Fork & Spoon
Tea towel
Sleeping bag
Thermal mat or camp stretcher Towel and face cloth
Torch and batteries Toilet bag
- toothbrush
- toothpaste
Gumboots - soap (in container)/body wash
Walking footwear / sneakers - comb or hairbrush
Jandals - pegs for clothesline

Raincoat (Waterproof!) Warm jersey

Matches or lighter Thermals (tops and bottoms)
Scarf Sun hat
Full uniform Sunscreen

Swimming gear Emergency food (personal)

Spare shirts Scroggin - energy food
Spare underwear
Spare shorts or trousers
Spare socks additional items:
Personal First Aid Kit
additional warm clothing
Personal first aid kit Pack Liner
Medication if any
Pocket Knife
Insect Repellent
Camera (in protective case)
PJ’s

Activity Leader notes:

2 day's in wanaka so non tramping gear for there (Jandals listed = for in showers at motels), tramping kit for Matukituki valley
th
tramp 27 - 29 .
Tents, cookers & pots to be supplied from hall

Parents/Caregivers can provide more information & special requirements:

August 2012 activity_consent_form_and_gear_list.doc