Boston

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Boston, MA - USS Salem CA-139 Heavy Cruiser

WHERE: Boston, MA.


WHEN: Saturday May 21st to Sunday May 22rd
MEET: Meet at 5:45 am at the Westbound Exit 49 Car Pool (Park & Ride) area off the LIE,
North Service Rd, Melville (Just East of Rte 110). We will leave at 6:00am.
RETURN: Your son will be brought home on Sunday (We will establish car pools. See Below)
COST: $100 per scout, covers registration, dinner Saturday and breakfast Sunday. Bring
money for additional activities and lunch on the way home. Each scout is to bring a
(NON PERISHABLE) bag lunch for Saturday and limited snacks.

$20 Deposit Fee & Permission Slip Due April 11th.


BRING A WATER BOTTLE. WE WILL NOT HAVE EXTRAS.
All medication, both prescription and over the counter, with written instructions,
need to be given to the adult leader in charge at the drop off point.

TROOP 409 DIX HILLS, NY


PARENT CONSENT AND EMERGENCY FORM

TRIP NAME: Boston Massachusetts DATE: May 21 – May 22, 2011

Scout Name: ____________________________________


In consideration of the benefits to be derived, and in view of the fact that the Boy Scouts of America is an
educational organization, membership in which is voluntary, and having full confidence that every precaution will be
taken to ensure the safety and well-being of my son during this activity or trip, I hereby agree to his participation and
waive all claims against the leaders of this activity or trip and officers, agents and representatives of the Boy Scouts
of America.
IN CASE OF EMERGENCY, I hereby give permission to the Physician selected by the unit leader or his designee,
to hospitalize, secure proper treatment for, and order injections, medications, anesthesia or surgery for my son as
named above.

Signed: _____________________________________ Date: _____________


(Parent or Guardian Signature)
Emergency Contact 1: _____________________________________ Phone # ____________________
Contact 2 other than Parent: ________________________________ Phone # ____________________
Physicians Name: _________________________________________ Phone # ____________________

Is Parent/Guardian Camping Overnight? ( Yes / No ) Name: ________________________________


Can Parent or Guardian Drive? ( Yes / No ) How many additional seats besides the Driver? ________
If Driving in Car Pool, Make & Model of Vehicle: _____________________________________
Is Vehicle, Insurance and Driver registered with Transportation Chairman ( Yes / No )

* Reason Scout Not Attending: __________________________________________________________

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