Parental Consent Form printable pdf download

A R E N TA L

O N S E N T

O R M

Please complete a separate form for each Scout. Every Scout coming to camp have completed this form.

Scout Name:

Troop #

Birthdate:

Age:

(

)

Address

Phone

City

State

Zip

e-mail:

I understand that participation in the various sessions and all other on off-site programs offered through the Occoneechee Council,

BSA summer camp program provides benefits to be derived by its participants. After carefully considering the risk involved in these

activities and in view of the fact that the Boy Scouts of America is an organization in which membership is voluntary, and having full

confidence that precautions will be taken to ensure the safety and well-being of my (son/daughter), I hereby give my consent for my

son/daughter:

______________________________________________________________________________

(Please print name of son/daughter)

to participate in the aforementioned selected activities. I waive all claims I may have against the Boy Scouts of America,

Occoneechee Council BSA, activity coordinator(s), all employees, volunteers or sponsors associated with the aforementioned

activities.

In case of emergency, I understand that 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 to secure proper treatment, including hospitalization, anesthesia,

surgery, or injections of medications for my child.

This form must have the signatures of both the participant and the parent (or guardian).

Participant Signature: ____________________________________________________________ Date: _____/_____/_____

Parent/Guardian Signature:________________________________________________________ Date: _____/_____/_____

In case of emergency contact: ___________________________________________ Day Phone: (_____)_____-_________

Parental Consent Form