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    2013 Approval by Parents Form

    Uploaded by

    Jim Brockman
    The document is an activity consent form and approval for parents or legal guardians. It provides information about an overnight trip from June 9th to 10th at a rod and gun club, requires signatures giving consent and permission for medical treatment, and provides contact information for participants and leaders.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    2013 Approval by Parents Form

    Uploaded by

    Jim Brockman
    36 views1 page
    The document is an activity consent form and approval for parents or legal guardians. It provides information about an overnight trip from June 9th to 10th at a rod and gun club, requires signatures giving consent and permission for medical treatment, and provides contact information for participants and leaders.

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    2013 Approval by Parents Form

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    © Attribution Non-Commercial (BY-NC)

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    The document is an activity consent form and approval for parents or legal guardians. It provides information about an overnight trip from June 9th to 10th at a rod and gun club, requires signatures giving consent and permission for medical treatment, and provides contact information for participants and leaders.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    36 views1 page

    2013 Approval by Parents Form

    Uploaded by

    Jim Brockman
    The document is an activity consent form and approval for parents or legal guardians. It provides information about an overnight trip from June 9th to 10th at a rod and gun club, requires signatures giving consent and permission for medical treatment, and provides contact information for participants and leaders.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Activity Consent Form and Approval by Parents or Legal Guardian

    This form is recommended for unit use to obtain approval and consent for Tiger Cubs, Cub Scouts, Webelos Scouts, Boy Scouts, Varsity Scouts, Venturers, and guests (if applicable) under 21 years of age to participate in a den, pack, team, troop, or crew trip, expedition, or activity. This form is required for use with flying plans and should be attached to the flying plan application. It is recommended that parents keep a copy of the form and contact the tour leader in the event of any questions or in case emergency contact is needed. Additional copies of this form along with the Guide to Safe Scouting are available for download from Scouting Safely at www.scouting.org/forms. First name of participant and middle initial ____________________________ ___Last name _______________________________ Address________________________________________ Birth date (month/day/year) ____/____/______ Age during activity _______ Additional address (need street address if you have a P.O. box) _________________________________________________________ City___________________________________________________________________________________State _____ Zip _________
    June 9th overnight at Concord Rod and Gun Club Has approval to participate in ___________________________________________________________________________________
    (Name of activity, orientation flight, outing trip, etc.)

    6/9/12 6/10/12 From ______________ to ______________.


    (Date) (Date)

    oWithout restrictions oSpecial considerations or restrictions: _________________________________________________________________________


    Hold Harmless Agreement
    I understand that participation in Scouting activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and have given consent for myself or my child to participate in this activity. I also understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation. In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participants parents or guardian, and/or determination of the participants ability to continue in the program activities. Participants signature ________________________________________________________________________ Date ____________ Parent/guardian printed name ___________________________________________________________________________________ Parent/guardian signature_____________________________________________________________________ Date ____________

    Area code and telephone number (best contact and emergency contact)

    Email (for use in sharing more details about the trip or activity)

    Contact the adult tour leader with any questions:


    Jim Brockman Name ______________________________________________________________________________________________________ 718 541 1135 jim.brockman@gmail.com Phone _____________________________________________________ Email____________________________________________
    680-673 2011 Printing

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