2026 - Oboz Wedrowniczy

Oboz Wędrownicze

Lipiec 2026
Imię Uczestnika*

First NameLast Name
Data Urodzenia*

YearMonthDay
Date
Stopień*
Szczep*
Adres Uczestnika*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Uczestnika Health Card Number*
XXXX-XXXX-XXXX-XX
Numer Komórki Uczestnika
Please enter a valid phone number.Format: (000) 000-0000.
Adres emaila uczestnika
example@example.com
Imię i nazwisko rodzica (jeśli masz mniej niż 18 lat)

ImięNazwisko
Numer Komórki rodzica
Please enter a valid phone number.Format: (000) 000-0000.
Adres emaila rodzica
example@example.com
Imię osoby w nagłych wypadkach*

ImięNazwisko
Numer telefonu w nagłych wypadkach*
Please enter a valid phone number.Format: (000) 000-0000.
Adres emaila w nagłych wypadkach*
example@example.com
WSZYSTKICH UCZESTNIKÓW OBOWIĄZUJE
- Przestrzeganie Prawa i Przyrzeczenia Harcerskiego.
- Posłuszeństwo, dyscyplina i porządek.
- Godność mundurowa, czyli czysty i wyprasowany mundur. Pełne umundurowanie składa się z rogatywki, koszuli z naszywkami, pasa harcerskiego, zielonych spodni oraz czarnych/ciemno brązowych pół-butów. Przypominamy, że Komenda Szczepu w każdej chwili posiada regulaminowe prawo zwolnienia członka z drużyny za niepoprawne zachowanie.
- Komenda nie bierze żadnej odpowiedzialności za osobistych przedmiotów uczestników, dlatego uczestnicy proszeni są o pozostawienie wszelkich cennych przedmiotów w domu. Członkowie kadry mają prawo skonfiskować zabronionych przedmiotów. Pamiętajmy, to jest biwak harcerski!
Nie umiem plywacJestem słabym pływakiemJestem silnem plywakemJestem Lifeguard I mam kwalifikacje
Dietary Restrictions
List any foods the participant should not eat for medical reasons:
Dietary Restriction List
Allergies / Asthma
List any allergies such as food, insect stings, drugs, etc. Clearly explain allergy and/or asthma symptoms. If reaction is severe, please make certain that the severity of the reaction is clearly indicated and whether the participant carries an EpiPen.
Does the participant carry any epinphrine autoinjector (e.g. EpiPen)?
Medical Conditions
List all medical conditions and provide details of usual treatment:
NosebleedsMigraine headachesSleepwalkingUrinary infectionsFainting spellsMedic alert informationChronic ear, nose, throat infectionsBed wettingOther
Please provide details of usual treatment for any identified conditions:
AngerPanic attacksDepressionAnxiety
Other:
AutismODDLDADDADHD
Other:
Medication
List any medication which will be taken by the participant during the activity. Self indicates the participant is in possession of the medication.
If necessary, may over the counter medications be administered in instances of fever, cold and/or minor discomfort (i.e. Tylenol, Motrin, Benadryl, cold syrup, etc.)?*
Has the participant received a Tetanus shot within the last 10 yrs? *
Date of last Tetanus shot:

YearMonthDay
Permission / Pozwolenie
I give permission for {imieUczestnika} to take part in the POLISH SCOUTING PROGRAM taking place from July 4th to July 18th, 2026 located at Kaszuby Ontario, Canada and Algonquin Provincial Park. Activities will include Overnight Camping, Canoeing, Portaging and Hiking up to 16+ km a day.
I confirm that the participant is physically and mentally fit to participate in the activities mentioned above, except those listed here:
Explain any limitations and restrictions
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 Understand
I Understand
I Understand
I Understand
In the event that medical care is required, I understand that every effort will be made to contact me. I acknowledge that in the case of an emergency, medical treatment may be sought by an Instructor and/or provided by health care practitioners without my consent. I hereby authorize the Scouting Instructors to secure such medical advice and services as may be required for the health and safety of myself or my child (or ward). I agree to accept financial responsibility in excess of the benefits allowed by my Provincial Health Plan and to reimburse registered camp staff for medical prescriptions purchased for my child.*

I Understand
By signing below, I agree 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 leaders and demonstrate a willingness to cooperate at all times to ensure the well being of other participants and counsellors. 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 Understand
Parent's Signature (if Participant is under 18)*
Parent / Guardian's Name*

First NameLast Name
Date

DayMonthYear
Date
Hour Minutes
Please verify that you are human*
Serdecznie dziękujemy za zainteresowanie, niestety lista uczestników jest zamknięta. Proszę wysyłać dalsze pytania do Namiestnik Wedrownikow hufca Karpaty, "wedrownicy.karpaty@zhp.ca". Proszę wziąć pod uwagę że syn niekoniecznie zostanie przyjęty na obóz. Będziemy z Państwem w kontakcie. Czuwaj! Komenda Obozu
Should be Empty:

Oboz Wędrownicze

Dietary Restrictions

Allergies / Asthma

Medical Conditions

Medication

Permission / Pozwolenie