Troop 205 is going on an outing on ____________ and will return on _____________
Time leaving: ___________________ Time returning: _______________
Cost: ______________ Place meeting or departing from: ____________________
Trip to: _______________________________________________________________
If you need to contact your Scout, and only in case of emergency, call ______________
phone # ____________________. It may be difficult to make contact, especially of hiking.
Please detach, retain this top section FYI and return the bottom of this form and any cost by:
In consideration of the benefits to be derived, and in view of the fact that the Boy Scouts of America is an educational institution, membership in which is voluntary, and having full confidence that every precaution will be taken to ensure the safety and well being of my Scout, namely: _____________________________ on the activity named below, I agree to his participation and waive all claims against the leaders of this trip, officers, agents, and representatives of the Boy Scouts of America, and the sponsor, Ebenezer United Methodist Church. In the event of an emergency, the Troop unit leader of the activity named below has my permission to obtain medical treatment for this Scout at the nearest hospital or doctor, at my expense, if our own doctor is not readily available, and as restricted on the Emergency Data Sheet on file with Troop 205.
Signature of parent or guardian, and date
EMERGENCY INFORMATION (IN ADDITION TO PERSONAL HEALTH AND MEDICAL RECORD)
During the activity listed above, I can be contacted at the following phones and will accept long distance calls.
If we are not available call _______________________ relationship ____________________________
at phone # (________) _______________________
This Scout is highly allergic or sensitive to: ________________________________________________
What if any medication is this Scout taking? _______________________________________________
Any special instructions for this medication? _______________________________________________
Do you want the unit leader to carry this medication? ________________________________________
Please use the back of this form for additional information and for explanation of any other problems the activity unit leader should be aware of.
Unit leader in charge of this outing: _____________________________ phone: ___________________