Troop 55 Parental Permission
EVENT:
DATE:
DEPART TIME:
RETURN TIME:
WHO SHOULD ATTEND:
COST:
EQUIPMENT:
UNIFORM:
PERMISSION SLIP TO BE RETURNED BY:
CONSENT FORM
APPROVAL BY PARENTS OR GUARDIANS
                                                                                                                                               _______
First Name of BSA member/guest and middle initial                                           Last name
                                                                                                                                               
Address                                                                                   Birth date (month/day/year)
                                                                                                                                               
Additional address (need street address if you have a P.O. box)
                                                                                                                                               
City                                                                                          State                            Zip
(           )                                                                           (        )                                             
Area code and telephone No. (parent's business)             Area code and telephone (home)
APPROVAL
(If two parents/guardians, both need to sign.)
FOR:                                                                                ON                        
    (Name of activity, outing, trip, etc.)                                      (Date[s])
Father/Guardian Signature                                             Date                      
Mother/Guardian Signature                           ______    Date                      
PARENTS OR GUARDIANS
(Please read all the statements on the page before giving approval for participation in the activity listed above.) I hereby approve and agree  to all of the terms, conditions, and wavier of claims of this CONSENT FORM and certify to its correctness. Further, I agree that this BSA youth member or guest can meet the health and physical fitness requirements of the trip or activity.
It is understood that in the event of a serious illness or injury, reasonable efforts to reach me will be attempted.
Medical Release
In the event of illness or injury occurring to my son
or daughter while involved in this trip or activity, I
consent to X-ray examination, anesthesia, and/or 
medical or surgical diagnostic procedures or treatment
considered necessary in the best judgment of the
attending physician and performed by or under the
supervision of a member of the medical staff of the        
hospital furnishing medical services.
Insurance company                                                 
Policy No.                                                                  
Physician                                                                
Telephone No.(      )                                              
Physician