|
Troop 413 Medical Release Form and Permission Slip
As
the parent or legal guardian of
(Insert Scout or
Adult Leader Name Name)
I, hereby, give my permission for him to participate in an outing with
Troop 413.
Dates of Outing:
September 17,18,19, 2010
Location:
Nantahala River;
Wesser, NC
Date of Departure:
Friday, September 17h , 2010
Time
of Departure:
4:00pm
Place of Departure:
Christ Covenant Church
Date of Departure:
Sunday, September 19, 2010
Time of Return:
2 pm
Place of Return:
Christ Covenant
Church
Cost of the Trip:
Scoutmaster in Charge:
Mr. Smith
tsmith@rescuenc.com
704-507-6152
Medical Information:
Please
List Any Medications to Be Taken on this trip: (If none, state "None")
Please indicate dosage amount & when medicine must be administered.
Pertinent Medical Information (allergies, limitations, etc.):
(If none
state "None)
Further, I give permission to the leaders of Troop 413, EMS personnel or
medical facility to render First
Aid or medical treatement, should the need arise. In the event of an emergency, I also give
permission to the physician, selected by the adult leader in charge, to
hospitalize, secure proper anesthesia, order injections, or secure other
medical treatment, as needed. I further agree to hold the above named
unit and its leaders blameless for any accidents that might occur during
this outing except for clear acts of negligence or non-adherence to BSA
policies and guidelines.
In
case of emergency, I can be reached by phone at:
By
clicking this option, I certify I am the legal parent/ guardian of the
scout listed above and herby approve my son to attend the above
outing.
Parent /Guardian
Electronic Signature
|
