Informed Consent and Hold-Harmless Agreement

I understand that participation in the ____________________camping trip, offered through

Corsicana Troop 258, involves a certain degree of risk. I have carefully considered the

risks involved and have given______________________________, my son, my consent to

participate from ________________________________.

In case of an emergency, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the physician selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child.

____________________________________
( Printed name of parent or guardian )

____________________________________
( Signature of parent or guardian )

____________________________________
( Date )

PLEASE PROVIDE THE EMERGENCY INFORMATION REQUESTED ON PAGE 2 OF THIS FORM. Click here for page 2