Boy Scouts of America – Troop 58

Permission Slip, Waiver of Liability & Information Form

 

Knowing that Scouting activities inherently involve some degree of risk to personal safety, but having full confidence that every reasonable precaution will be taken to ensure the safety of my son(s),

__________________________,________________________, ____________________________,  

I hereby give permission for him (them) to attend the following Scouting event:

_____________________________________________________________________________________

From (insert dates):  ________________________________to:__________________________________

at (insert location):______________________________________________________________________

and to allow him (them) to participate in all scouting-related activities, including but not limited to hiking, camping, skiing, boating/canoeing, swimming, climbing etc.

I hereby wave all claims against the leaders of this trip and their families, and give permission for them, in their discretion, to provide first aid and emergency treatment; and to seek emergency medical, dental or surgical care as they deem necessary for my son(s). In addition to having supplied an accurate and up-to-date medical form (on file with Troop 58), I have indicated below any additional concerns (medical or other) that may apply to my son during this trip:

 

____________________________________________     ___________________

(Parent Signature)                                                                   (Date)

 

Parents Name(s), Emergency phone number(s)

 

(1)__________________________________________; (2)_________________________________________

 

Home Phone, if different________________________ Cell Phone ______________________

E-mail ____________________________________________

 

Other required information

 

Residence Address: _____________________________________________________________________

 

Scouts Age:______, Scouts Rank:______________  Faith/ Religion:______________________________

 

Allergies, or restrictions/limitations:________________________________________________________

Are medications being sent Y/N ____ ( see instructions in the packing list )

I will drive ____# of people to this event; ____# of people Home from this event

Car Brand/Model/ Year______________________ How Many Seat Belts ______________

Liability coverage for each person, $___________

Liability coverage for each accident, $ ____________ Property Damage $__________