Troop 82 is planning a trip to__________________________on_____________ 200__. If you want your son to attend this trip, please complete this form, sign it and return it, with the proper amount of money for the trip, in the money collection envelope, to the Scoutmaster.

SCOUT'S NAME_______________________________SCOUT'S AGE_______________

PARENT'S NAME______________________________________________________

ADDRESS_____________________________________________________________

HOME PHONE # _________________EMERGENCY PHONE #_________________

In consideration of the benefits to be derived, and in view of the fact that the Boy Scouts of America is an educational institution, membership in which is voluntary, and having full confidence that every reasonable precaution will be taken to ensure the safety of my son on this trip, I hereby agree to his participation in the event described above and waive all claims against the leaders of this trip and officers, agents, and representatives of the Boy Scouts of America.

____________                   ___________________________

(Date)                                   (Signature of Parent or Guardian)

In case of emergency, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the physician selected by the adult leader in charge of this trip to secure proper treatment, including hospitalization, anesthesia, surgery, medication, or injections of medication for my child. Please note that my child is allergic to____________________________________________________________________________

______________________________________________________________________________

_____________                         ___________________________

(Date)                                            (Signature of Parent or Guardian)

Medications

My son is currently being treated for__________________________________________

and is currently taking______________________________________________________

(Medication)

 

____I will not be participating.                         ____I can bring ____Scouts to the activity.

____I will be participating.                               ____I can bring ____Scouts to Kosciolek Hall.

AUTO INFO:

INSURANCE COMPANY__________________________________________

VEHICLE MAKE_______________MODEL_____________YEAR_____

MARKER_____________DRIVER LICENSE#_______________________