Permission for Scout To Participate in a Troop 75 Event

PERMISSION, RELEASE, AND INDEMNITY AGREEMENT

TO THE SCOUTMASTER & LEADERS OF TROOP 75, BOYSCOUTS OF AMERICA:

THIS PERMISSION, RELEASE, AND INDEMNITY AGREEMENT HEREBY PROVIDES YOU THE FOLLOWING, TO WIT:

  1. AS PARENT OR LEGAL GUARDIAN OF THE CHILD LISTED BELOW, YOU HAVE MY PERMISSION AND CONSENT FOR MY SON, OR WARD, TO ACCOMPANY TROOP 75 ON THE BOYSCOUT ACTIVITY LISTED PREVIOUSLY.
  2. I RECOGNIZE AND ACKNOWLEDGE THAT ACCIDENTS AND INJURIES CAN AND DO SOMETIMES OCCUR DURING SCOUTING ACTIVITIES AND TRIPS. I HEREBY INDEMNIFY, RELEASE, AND HOLD HARMLESS THE SCOUTMASTER, TROOP 75, ITS LEADERS, DESIGNEES, AND ASSIGNEES IN THE EVENT OF ANY ACCIDENT OR INJURY TO MY SON OR WARD.
  3. THE SCOUTMASTER, ANY OF TROOP 75 ADULT LEADERS, OR THEIR DEISGNEES AND ASSIGNEES, MAY, IN THE EVENT OF A MEDICAL EMERGENCY, ADMINISTER FIRST AID AND/OR SEEK AND PROCURE MEDICAL TREATMENT AS DEEMED NEEDED AND APPROPRIATE FOR MY SON OR WARD. THIS MAY INCLUDE, BUT IS NOT LIMITED TO: INJECTIONS, ANESTHESIA, SURGERY, OR TREATMENT AS PRESCRIBED OR RECOMMENDED BY THE AVAILABLE MEDICAL PERSONNEL. I AGREE THAT I, OR MY INSURANCE, WILL BE RESPONSIBLE FOR THE COST OF ALL SUCH TREATMENT. I HEREBY INDEMNIFY, RELEASE, AND HOLD HARMLESS THE SCOUTMASTER, TROOP 75 LEADERS, THEIR DESIGNEES AND ASSIGNEES, AND TROOP 75 WITH RESPECT TO THEIR SEEKING AND PROCURRING ANY MEDICAL ATTENTION AND TREATMENT FOR MY SON OR WARD.
  4. BY SIGNING THIS FORM, I AFFIRM THAT I HAVE READ, APPROVE, AND CONSENT TO THE FOREGOING PERMISSION, RELEASE AND INDEMNITY PROVISIONS OF THIS DOCUMENT.

Scout’s Name: __________________________________________________________________

Parent Signature: _________________________________________ Date: ____________________

Please fill in medical information if anything has changed

Healthcare Provider (Name of Insurance Co.): _________________________________________

Physician’s Name: _______________________ Physicians #: _____________________________

Allergies or Medical Conditions: ___________________________________________________

Parent’s Names:

Father: __________________________ Home # ___________________ Cell # _______________

Mother: _________________________ Home # ___________________ Cell # _______________

Emergency Contact Name: ________________________ Emergency Contact #: ______________

　　

Greers Ferry

September 7-9, 2007

Scout Name _______________________ Parent Name__________________

(Please Print) (Please Print)

Dear Scouts and Parents,

In order to make the planning of this trip easier, please fill out the required information on this sheet. We must have enough drivers to take scouts to the campsite, or some scouts may be unable to go. If you can attend the campout, and/or provide transportation, please be sure to annotate that on this sheet. (These sheets are due back to the outdoor coordinators by Thursday Sep. 6, 2007)

Payment will be collected by Sep. 6 or sooner, if possible. Please pay Mary Gruber. If your scout will be paying from his account, please let us know. If you are buying the food for your patrol, receipts are requested to be turned in as soon as possible or by the first Monday meeting following the campout. Rick Gruber will be handling the organization of transportation.

Cost

1. Food $12.00 per person

2. Transportation Fees $10.00 per scout (only if scout needs transportation)

 

Total Due _______________ Date Paid _______________

(filled out by Coordinator)

Please check Yes or No

Yes No

____ ____ My scout will be attending the activity

____ ____ I will be attending the campout with my scout

____ ____ I can provide transportation for myself, my scout and

______ other scouts.

____ ____ My scout will need transportation.

___________________________ _________________________

Signature of Scout Signature of Parent