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Troop 413 Medical Release Form and Permission Slip
(Beta Version)
As
the parent or legal guardian of
(Scout Name)
I, hereby, give my permission for him to participate in an outing with
Troop 413.
Dates of Outing:
February 12,13,14 2010
Location:
Camp Grimes, Dysartsville, NC
Date of Departure:
Friday, February 12th , 2010
Time
of Departure:
4:00pm
Place of Departure:
Christ Covenant Church
Date of Departure:
Sunday, February 14, 2010
Time of Return:
12:00pm
Place of Return:
Christ Covenant
Church
Cost of the Trip:
$35
Scoutmaster in Charge:
Mr.
Cline
Medical Information:
Please
List Any Medications to Be Taken on this trip: (If none, state "None")
Pertinent Medical Information (allergies, limitations, etc.): (If none
state "None)
Further, I give permission to the leaders of Troop 413 to render First
Aid, 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 injection, 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:
(Home) or
(Cell).
If
I cannot be reached, please contact
(name)
at
(Phone)
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
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