Zgłoszenie na Rok Harcerski 2024/25 ZHP DUNAJEC

Zgłoszenie na Rok Harcerski 2024/25 ZHP DUNAJEC
Związek Harcerstwa Polskiego - Polish Scouting Association in Canada

Permission Form / Pozwolenie
Contact Email Address*
example@example.com
Participant Information
Participant's Name*

First NameLast Name
Gender*

MaleFemaleN/A
Participant's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date of Birth
Health Card Number*
Home Phone Number*
Telephone Number
Jednostki

Gromada Zuchów "Orleta”
Gromada chłopców w wieku 7-10 lat (klasa 2 – 5)

2-ga Drużyna Harcerzy
Drużyna chłopców w wieku 11-15 lat (klasa 6+)

11-sta Drużyna Wędrowników
Drużyna młodzieży w wieku 16+ lat
Jednostka*

Gromada Zuchow "Orleta” (chlopaki)2-ga Drużyna Harcerzy11-sta Drużyna Wędrowników
Stopień Harcerski
Parent(s)/Guardian(s) Information
Parent(s)/Guardian(s) Name(s)*
Parent 1 Phone Number*
Please enter a valid phone number.
Parent 2 Phone Number
Please enter a valid phone number.
Emergency Contact
Emergency Contact Name*
Emergency Contact Phone Number*
Please enter a valid phone number.
Health Information
Allergies*
(if none, "N/A")
Medical Conditions*
(if none, "N/A")
Dietary Restrictions*
(if none, "N/A")
Does the participant carry a epinephrine autoinjector (EpiPen)?*

YesNo
Year of last Immunization for Tetanus:
I give permission for participant's name and surname* to take part in weekly meetings (zbiórki) and trips (wycieczki) taking place from September 2024 to June 2025 in the Greater Hamilton Area and within Ontario.
Description of activities involved:

arts and crafts, singing, various indoor and outdoor games, sports, day trips to parks and local activities, and campfires.
I confirm that participant's name* is physically and mentally fit to participate in the activities outlined above, except those listed here: (explain any limits on participation)
I understand that the activities involve a certain degree of risk that could result in damage to person or property, injury or even death. After carefully considering the risk involved, and in view of the fact that Polish Scouting Association is a not-for-profit organization, I hereby release, hold-harmless and waive all claims associated with this activity which I may have against Polish Scouting Association in Canada and Polish Scouting Association in Canada (Ontario) Inc., and their employees, officers, directors, agents, volunteers and members. I further understand that photographs and/or videos may be taken during this scouting activity by the organizers, and the resulting images may be used in the Association’s brochures and promotional materials including the Association’s electronic media, without further notice to me, and I consent to such use. I understand that, in the event my child is sent home due to a violation of the standards of conduct, I will bear all costs of the transport home and I acknowledge that I will receive no reimbursement of any fees.*

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The participant agrees to abide by all rules, regulations and procedures and standards of conduct as prescribed by the Polish Scouting Association in Canada and its units. In particular, I agree that I will respect the authority of the counsellors and demonstrate a willingness to cooperate at all times to ensure the wellbeing of other participants and counsellors.*

Yes
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary. *

I agree
Completion of this form indicates consent to the collection and use of this information by the Polish Scouting Association.
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Zgłoszenie na Rok Harcerski 2024/25 ZHP DUNAJEC

Związek Harcerstwa Polskiego - Polish Scouting Association in Canada

Participant Information

Parent(s)/Guardian(s) Information

Emergency Contact

Health Information