Parent Permission Form
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1SAN DIEGO - IMPERIAL COUNCIL
BOY SCOUTS OF AMERICA
PARENT PERMISSION FORM
UNIT INFORMATION
Unit Type
Pack
Troop
Team
Crew Unit # ______ is planning a ___________________________________________________
Date/s: From: ___ / ___ / ___
To: ___ / ___ / ___
Time From: ____ : ____
AM
PM
To: ____ : ____
AM
PM
Location _________________________________________________________________________ Site Phone (
) _________________
ARRANGEMENTS FOR TRANSPORTATION
Time and place of departure ____________________________________________________________________________________________
Time and place of return _______________________________________________________________________________________________
Mode of transportation ________________________________________________________________________________________________
LEADERS
Leader’s Name ___________________________________________________ Position ____________________________________________
Leader’s Name ___________________________________________________ Position ____________________________________________
EXPENSES
Expenses Required ___________________________________________________________________________________________________
Equipment and Clothing _______________________________________________________________________________________________
Camping _______________________________________ Food ____________________________________ Gas _______________________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Only youth with signed permission may participate / Return this portion to the leader by ___ / ___ / ___
EMERGENCY CONTACT
In case of unusual circumstances (major delays, etc.), the leader will contact:
Name ____________________________________ Day Phone (
) ___________________ Evening Phone (
) ___________________
Name ____________________________________ Day Phone (
) ___________________ Evening Phone (
) ___________________
IF I CANNOT BE REACHED IN THE EVENT OF AN EMERGENCY, THE FOLLOWING PERSON IS AUTHORIZED TO IN
MY BEHALF:
Name ____________________________________ Relationship to Participant ____________________________________________________
Address _________________________________________________________________ City _________________ State ____ Zip _________
Day Phone (
) ___________________ Evening Phone (
) ___________________
Physician’s Name __________________________________________________________________ Day Phone (
) ___________________
Additional remarks, allergies or special medical consideration regarding my son _____________________________________________________
____________________________________________________________________________________ Date of Last Tetanus ___ / ___ / ___
Who Will Notify the Parents: Leader _____________ Day Phone (
) ___________________ Evening Phone (
) ___________________
My child _________________________________________________________________________________________ has permission to
participate in ______________________________________________________________________________________ Date ___ / ___ / ___
He/She is in good health and may engage in all activities
YES
NO. If NO, list any exceptions: ___________________________________
___________________________________________________________________________________________________________________
During the activity, I may be reached at: Address __________________________________ City _________________ State ____ Zip _________
Day Phone (
) ___________________ Evening Phone (
) ___________________
In case of an emergency, if none above can be contacted, I consent to treatment for my child under the supervision of and as deemed advisable by a
physician licensed under the Medicine Practice Act. This provides authority pursuant to Section 25.8 of the California Civil Code.
Parent or Guardian’s Name _____________________________________ Signature ______________________________ Date ___ / ___ / ___
(PLEASE PRINT)
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