Bsa Climbing Consent Form - Parental Informed Consent And Hold Harmless/release Agreement


Ventura County Council BSA
I understand that participation in the Climbing program offered through the Ventura County
Council, BSA, involves a certain degree of risk that could result in injury or death. In
consideration of the benefits to be derived and after carefully considering the risk involved
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 have carefully considered the risk involved and have given:
(Please Print) (Name of person under age 18)
my consent to participate in the Climbing program, and waive all claims I may have against the
Boy Scouts of America, Ventura County Council, Climbing Directors and Instructors, all
employees, volunteers, or sponsors associated with the Climbing Merit Badge, Climbing Tower
or Climbing program.
In case of emergency, I understand 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. I request that measures be instituted without delay as
the judgment of medical personnel dictates.
Stoney Point Park
This is for the climbing outing to be held at: ________________________________________,
Saturday 8/29/15
Saturday 8/29/15
from: ____________________________ (date), to: ____________________________ (date).
This form must have signatures of both parents (guardian) (if required):
Signature: __________________________
Signature: __________________________
Print name: __________________________
Print name: __________________________
Date: __________________________
Date: __________________________
Note: This form does not replace the troop’s Activity Consent Form.
Both forms must be completed.


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