Troop 201 Scout (name) ___________________________________________________________will attend

The above Scout will be under the supervision of the Scoutmaster or his authorized representatives, and will be expected to follow the Scout Law during this outing. The parents of the above Scout will be called and requested to pick up their Scout from this outing if they are repeatedly disruptive or disrespectful.

Name of Parent __________________________________________________________________ will attend

Name of Parent __________________________________________________________________ will attend

In the event of illness or injury occurring to my son, I give permission to the officers, leaders or agents of the Boy Scouts of America, Verdugo Hills Council, to obtain and administer such medical aid or assistance as might be required, including X-Ray, anesthesia, medical or surgical diagnostic procedure or treatment necessary in the best judgment of the attending physician. In no event will The Boy Scouts of America, Verdugo Hills Council, its official leaders or agents, or the Magnolia Park Methodist Church be held liable for any first aid rendered or treatment pursuant to this consent. In the event of a serious injury or illness, reasonable efforts will be made to reach the parent.

List all medications (labeled) and dosages, restrictions, allergies, precautions or special notes for above Scout:

__________________________________________________________________________________________

__________________________________________________________________________________________

Signature of Parent or Guardian: _______________________________________________ Date ____________

Name of Parent or Guardian: ______________________________________ Home Phone __________________

Work Phone _____________________ Cell Phone ______________________ Pager _______________________

TRANSPORTATION:

______ I will be able to drive ______ people (including self).

______ I will be able to transport Troop/Patrol equipment.