 Troop 60Southbury, CT PERMISSION SLIP |
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 precaution will be taken to ensure the safety of my son(s) in this activity, I hereby agree to his participation and waiver all claims against the leaders of this trip and officers, agents and representatives of the Boy Scouts of America. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the adult leader in charge to hospitalize, secure proper anesthesia, or to order injection for my son(s). |
SCOUT'S NAME:______________________________________________________________ SIGNATURE OF PARENT:_______________________________DATE:__________________ ADDRESS:___________________________________________________________________ HOME TELE:______________________EMERGENCY TELE:_________________________ BEEPER TELE:_______________________________________________________________ MEDICAL INSURANCE:________________________________________________________ MEDICAL INFORMATION:_____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ |