Permission Slip
^{You really should be using the permission slip you received at the troop meeting!
You must call your patrol leader for place and time and for requirements for participation.
For High Adventure activities (backpacks, canoe trips, etc.) contact the Trek Leader for information.}

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_{Trip Destination: ______________________________________________
Leave: ______________________________________________
Return: _____________________________________________
Mandatory meeting: __________________________________
This permission slip MUST be received by_____________
Special equipment:___________________________________
Cost: _______________________________________________
Permission slips due: _______________________________
WE NEED DRIVERS.}

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APPROVAL OF PARENTS OR GUARDIANS OF _________________________ Trip destination:____________________________________________ Parents or guardians must read this statement, before approving application.

I hereby approve and agree to all of the terms and conditions of this application and certify to its correctness. Further, I certify that this Scout can meet the health and physical fitness requirements of the Troop trip or activity. Water Activities In the even that the Troop trip or activity takes place in total or in part on or near water, I certify that this Scout is (check one): __nonswimmer __beginner __swimmer __BSA lifeguard All such activities are to be conducted within the guidelines of the Safe Swim Defense, No. 7369A and/or Safety Afloat, No. 7368, as may be appropriate. Waiver of Claims In consideration of the benefits to be derived from participation in this Troop trip or activity, any and all claims against the Boy Scouts of America or its local councils, Boy Scout Troop, and chartered organization, or against the officers, employees, agents, or other representatives of any of them, or any other persons working under their direction or engaged in the conduct of their affairs, arising out of any accident, illness, injury, damage, or other loss or harm to/or incurred or suffered by the applicant named above or to his or her property, in connection with or incidental to the Troop trip or activity, including preliminary training and travel, are hereby expressly waived by the applicant and the applicant's family or guardians.

Medical Release In the event of illness or injury occurring to my son while involved in this Troop 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. It is understood that in the event of a serious illness or injury, reasonable efforts to reach me will be attempted. Insurance company _____________________________ Policy no._____________________________________ Personal physician ______________________________ Dr. Telephone number __________________________ Emergency Contact If I am unavailable in case of emergency or early return, I authorize the following to pick up my son in my absence: Name _______________________________________ Relationship __________________________________ Telephone ___________________________________ Approval Signature ____________________________________ Date ________________________________________ Telephone ___________________________________

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