Hufiec Watra Rejestracja na Rok

Hufiec Watra Registration

Year of 2024-2025
Na Rok
Participant Information
Full Name*

First NameLast Name
Szczep*
Jednostka*
Czy Druhna będzie pełnić funkcje przez ten rok harcerski?

YesNo
Gender

MaleFemale
Stopień Harcerski
Stopień
Participant is 18+*

YesNo
Participant's Email
example@example.com
Participant's Phone number (optional)
Date of Birth*

MonthDayYear
Health Card Number
Participant's Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent/Guardian Information

Parent/Guardian #1 Details
Full Name*

First NameLast Name
Phone Number*
Parent #1 Email*
Adres emailowy podany przez rodzica będzie służył do komunikacji ze szczepową/ drużynową oraz przekazania informacji dotyczących programu harcerskiego.
Zgadzam się podzielić adresem emailowym z KPH mojego szczepu aby otrzymywać emaile z informacjami o akcjach, które organizowane są w celu wspierania Szczepu do którego moje dziecko/ci należą.*

TakNie
Parent/Guardian Information

Parent/Guardian #2 Details
Full Name

First NameLast Name
Phone Number
Parent #2 Email
Adres emailowy podany przez rodzica będzie służył do komunikacji ze szczepową/ drużynową oraz przekazania informacji dotyczących programu harcerskiego.
Emergency Contact Details

Please specify who to contact in the event of an emergency if parents/guardians are unreachable
Full Name*

First NameLast Name
Phone Number*
Relationship to Participant*
Funkcyjne
Czy Druhna ma pełny naramiennik?

YesNo
Grupa Wieku

Under 1818-2425+
Proszę napisać wszystkie funkcje które Druhna będzie pełniła przez ten rok harcerski.
Please include the funkcja, jednostka, and szczep/hufiec.
Do you have a valid Police Check completed

YesNo
Please attach a copy of your completed Police Check.

Cancelof
Zobowiązanie

Proszę przeczytać zobowiązanie i podpisz poniżej, wskazując, że wyrażasz zgodę.

Zobowiązuję sięświadomie i dobrowolnie, dokładając wszelkich sił prowadzić powierzony mi zespół w myśl idei i zasad wychowawczych Z.H.P.
Będę się starała pogłębiać i rozszerzać swoje wiadomości harcerskie i pedagogiczne i przygotowywać swoją następczynię. Podejmuję się pełnej odpowiedzialności za sprawy finansowe i administracyjne powierzonej mi drużyny i zobowiązuję się czuwać nad jej majątkiem. Nie opuszczę drużyny bez zgody Hufcowej. Wyznaczonej następczyni przekażę drużynę i jej majątek.
Signature

Clear
Date*

MonthDayYear
Date
Health Form
List any allergies such as food, insect stings, drugs, etc. Clearly explain asthma symptoms. If reaction is severe, please make certain that the severity of the reaction is clearly indicated. If more space is required to explain the medical concern, please attach the explanation below.
Does the participant have any allergies or asthma?*

YesNo
Allergies:
Please write N/A if none apply.
Does the participant have an EPI Pen*

YesNo
Psychological or emotional difficulties (ex. Anger, Panic Attack, Depression, Anxiety etc), Neurological or behavioural disorders (ex. Autism or ODD, LD, ADD, ADHD)
Please list any medical conditions, physical limitations or any other concerns which might affect participation in the program.
Medical Conditions: *
Please write N/A if none apply.
List any foods the participant should not eat for medical reasons. If foods are life threatening, explain the symptoms.
Dietary Restrictions: *
Please write N/A if none apply.
Medical Conditions: Please check off any life threatening conditions, physical limitations or any other concerns which might affect participation in the program.
Epilepsy

YesNo
Migraines

YesNo
Nosebleeds

YesNo
Digestive Upsets

YesNo
Sleepwalking

YesNo
Diabetes

YesNo
Bleeding Disorder

YesNo
Bed Wetting

YesNo
Fainting Spells

YesNo
Chronic Ear, Nose, Throat Infections

YesNo
Urinary Infections

YesNo
Medic Alert Info

YesNo
Medic alert for:
Please write N/A if none apply.
Other: Please Specify
Details for usual treatment
Please write N/A if none apply.
Medication (information required for overnight trips - The medication being carried by the participant will be monitored by an Instructor)
If necessary, may over-the-counter medications be administered to relieve minor discomfort, fever, and/or colds (i.e. Tylenol, Advil, cold syrup)?

YesNo
Has the participant received a Tetanus shot in the last 10 years?*

YesNo
Date of last Tetanus shot:

MonthDayYear
Date
In case of severe or life threatening medical condition, please upload a physician's permission to take part in scouting activities.

Cancelof
Additional Comments:
Permissions
I give permission for the participant to take part in weekly scout meetings run by Polish Scouting Association (Hufiec Watra) from September 1st 2024 to June 30th 2025. Scout meetings may take place at various locations specified by group leaders. Activities during the meetings will include singing, pioneering, playing all types of games and sports, scouting, walking, running. Some activities might involve biking, skating, cooking, using tools, etc.

I confirm that the participant is physically and mentally fit to participate in the activities outlined above, except those listed here: (explain any limitations on participation)
I give permission for the participant to take part in all activities, except for:*
Please write N/A if none apply.
Parent's Signature (if participant is under 18) *

Clear
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.
Date:*

MonthDayYear
Date
Participant's Agreement

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.
Participant's Signature*

Clear
Date*

MonthDayYear
Date
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
Once you click submit, you will be emailed a copy of your response. You may use the link in that email to modify your response if needed.

Czuwaj!

Hufiec Watra
Should be Empty:

Hufiec Watra Registration

Participant Information

Parent/Guardian Information

Parent/Guardian Information

Emergency Contact Details

Funkcyjne

Health Form

Permissions