TROOP 29 TRIP PERMISSION FORM

SECTION I: (keep for your information)

The Adult Leaders in charge of this activity will be:

........................................................................................................ tear here ........................................................................................................

SECTION II: (return to trip coordinator)

PARENTAL INFORMED CONSENT AND HOLD HARMLESS/RELEASE AGREEMENT

I understand that participation in the above activity, offered by Troop 29, involves a certain degree of risk that could result in injury or death.  In consideration of the benefits to be derived, and after carefully considering the risk involved, and in view of the fact that Boy Scouts of America is an organization in which membership is voluntary, and having full confidence that precautions will be taken to ensure the safety and well-being of my child, I have given the scout named below my consent to participate in the troop and waive all claims I may have against the Boy Scouts of America, Golden Empire Council, Troop 29 Adult Leaders, activity coordinators, employees, volunteers or sponsors associated with the activity.  In case of 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 leaders in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child.  Please note special health conditions on reverse side of Section II.

Scout name _______________________________________________ Health note on reverse side?      yes       no

Medical Insurance Company ______________________________________ Medical No. ___________________

In case of emergency, I can be reached by phone at _______________________ or ________________________

If I cannot be reached, please contact __________________________________ at ________________________

I will be attending this event            yes       no                I am able to drive ________________ (number of passengers)

Signed (parent or guardian) _______________________________________ Date_________________________