GENERAL INFORMATION (FOR ALL CLUB MEMBERS) NAME: __________________________________________Sex: _______________ Club. _________________________________ Church: ______________________ Conference/Mission: _________________________Union:____________________ PATHFINDER INFORMATION: Date of birth: _______/____/_____/ Place of birth:__________________________ Number of Camporees you participated in: ___________ Weight (kg) _________ Height: __________ Blood Type: _____________________ Address: ________________________________________________Tel.________________ IF YOU ARE NOT A PATHFINDER, FILL IN THIS INFORMATION: Time as a Master Guide: _______ Number of Camporee you attended: _________ What is your function in the club: (mark the option) Director, Associate, Secretary, Chaplain, Instructor, Counselor, Captain, Unit Secretary, Other: _______________________________________ Address: ____________________________________________Tel: ____________ HEALTH INFORMATION Do you suffer from some kind of sickness that needs special treatment? YES__ NO __ If your answer is YES, indicate what it is and what is required: ___________________________________________________________________ ___________________________________________________________________ Are you bringing along some kind of medical treatment? ___________________________________________________________________ Are you taking any special medication? ____ Which one? ____________________ How frequent are you taking it? ___________________________________________________________________ Allergies: YES ___ NO ___ to what, if you answer positively____________________ Which medicine should be used? ___________________________________________________________________ ___________________________________________________________________ Are you allergic to some kind of medication?____ If so which one? ___________________________________________________________________ Observations: The director of the Club has to give a copy of this form to each Pathfinder and it should be kept in your folder and a copy should be given to the Conference/Mission.