PERMISSION
Boy Scouts of
Dear Parent or Guardian
This
form is required for all Troop 52 trips. No boy may go on a trip without
providing this form prior to travel. The Assistant Scoutmasters and I will do
everything in our power to protect your son. Two adults will be present at all
activities. At least one trained adult will be present on all trips
Sincerely,
Robert Fedge
Scoutmaster, Troop 52
I
hereby give permission for my son to be transported, including travel outside
the State of
Trip
destination:_____Whitewater Challengers Whitehaven
PA ________
Permission
is valid for (trip dates): ___June 6th, 2008 through June 8th, 2008__________
Scout's
Name: ___________________________________________________
Address:
_______________________________________________________
City,
State, Zip: __________________________________________________
Home
Phone #: ________________________
Emergency Phone #: ________________________
In
consideration of the benefits to be derived, and in view of the fact that Boy
Scouts of America is an educational institution, membership in which is
voluntary, and having full confidence that every precaution will be taken to
ensure the safety of my son on this activity, I hereby agree to his
participation and waive all claims against the leaders of this trip and
officers, agents and representatives of Boy Scouts of America.
MEDICAL INFORMATION
Check
any and all that apply:
____ Allergy to a medicine,
food, plant, animal, insect or toxin
____ Any conditions that may
require special care, medication or diet
____ ADD/ADHD
____ Asthma
____ Convulsions ____ Heart Trouble ____Contact
Lenses ____ Diabetes
____ Fainting
Spells _____ Bleeding Disorders
Limitations
of physical activity:
____________________________________________________________________________
MEDICAL EMERGENCY
In
case of accident, injury or illness while
participating in Troop activities, I hereby give my permission to the
doctor selected by the adult leader in charge to secure proper treatment,
including hospitalization, anesthesia, surgery or injections of
medications. .
Signature
of Parent or Guardian_________________________________________________
Date: ___________________
Print Name:
_____________________________________________
Relationship: ________________
Revised