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Gold Qualifying Health Form

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Part I – to be completed by the event coordinator or first aider

Name of event/activity

Gold Qualifying Expedition 2022
Start Date

8th August 2022
End Date

11th August 2022
Person responsible for first aid at the event

Helen Cook
Part II - to be completed by:

- parents* of participants (including children of volunteers) under the age of 16 - members of Rangers aged 16 and over - adult volunteers attending a girl event (if adults wish to keep their health information confidential they may carry it in a sealed envelope that will be opened only in the case of an emergency). NOTE: Over-16s attending a 16+ event are NOT required to complete this form.
Participant details

General Health Information


Please label young members’ medication with their name and provide clear instructions for its use (whether or not she self-medicates, dosage etc). Inhalers and EpiPens:

Ensure a spare, clearly labelled inhaler or EpiPen is brought to event, to be held by first aider.
Emergency Contacts

Please provide details of a person who will be contactable at all times during the event/activity
Please provide details of a second person who will be contactable at all times during the event/activity

I authorise the Leaders and first aiders at this event to give permission for my child to receive any emergency dental, medical or surgical treatment, including anaesthetic, as considered necessary by the medical authorities present.

Arrangement for return of form

This form will be electronically submitted to the event organiser. Your personal data will be used to support the organising and running of this event, support your experience throughout this website, and for other purposes described in our privacy policy

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