Bsa Troop 52 Activity Consent Form And Approval By Parents Or Legal Guardian For 2014

BSA TROOP 52 ACTIVITY CONSENT FORM AND APPROVAL BY PARENTS OR LEGAL GUARDIAN

for 2014 – 2015

It is recommended that parents/guardians keep a copy of the form and contact the tour leader in the event of any questions or in

case emergency contact is needed. The Guide to Safe Scouting is available for download from Scouting Safely at

Participant Name (First, Middle Initial, Last) _________________________________________________

Birth Date (month/day/year) ____/____/____

Age during activity ________

Address ______________________________________

City, State, Zip _______________________

Has approval to participate in (all parents/guardians must initial each trip the participant has permission to attend and please note

that electronic sign-ups for each event are still required):

_____

Minnewaska Base Camp/Hike

_____Delaware River Canoe Trip

_____ Thanksgiving Tinicum Park

09/26/2014-09/28/2014

10/17/2014-10/19/2014

11/21/2014-11/23/2014

_____

Gettysburg

_____ Klondike

_____ Battleship Massachusetts

12/12/2014-12/14/2014

01/23/2015-01/25/2015

02/20/2015-02/22/2015

_____

Fort Mifflin Camping

_____ Backpacking Rickets Glenn

______ Canoe trip Assateague or Pine Barrens

03/27/2015-03/29/2015

04/24/2015-04/26/2015

05/15-05/17

____Without restrictions

____ Special considerations or restrictions: __________________________________________________________

______________________________________________________________________________________________

HOLD HARMLESS AGREEMENT

I understand that participation in Scouting activities involves a certain degree of risk and can be physically, mentally, and emotionally

demanding. I have carefully considered the risk involved and have given consent for myself or my child to participate in this activity. I

also understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and

standards of conduct. I release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers,

related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.

In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I

hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including

hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the

adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant,

follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to

continue in the program activities.

Participant’s signature: _______________________________

Date: ______________

Parent/Guardian #1 Printed Name: ________________________________ Signature/Date: _______________________________

Parent/Guardian #2 Printed Name: ________________________________ Signature/Date: _______________________________

Phone #s (for emergency contact): ________________________________ Email Addresses (for trip details): __________________

Contact the Scoutmaster or Tour Leader with any questions:

Scoutmaster: Alberto Dioses, , mobile (908) 285-6444

Tour leader: Contact details listed on , (Click on the event name to expose the Tour

Leader contact details)

Bsa Troop 52 Activity Consent Form And Approval By Parents Or Legal Guardian For 2014 - 2015

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