Loko

Permission Slip
September 2012 Pack 41 Camp Out

As the parent or legal guardian of ___________________________, I hereby give my permission for this child to participate in an outing with Pack41, along with the following siblings under the age of 18:
Name:_____________________________________ Age:_____________
Name:_____________________________________ Age:_____________Name:_____________________________________ Age:_____________


Location: Camp Currier, Eudora, MS
Activity: Camping
Arrival Time: 6:00 PM Date: 09/28/2012
Departure Time: 12:00 PM Date: 09/30/2012

I understandthat participation in Cub Scout activities involves a certain degree of risk. I have carefully considered the risk involved and have given consent for myself or my child to participate in theseactivities. I understand that participation in these activities 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 ofthis participation.

I approve the sharing of the information on this form with BSA volunteers and professionals who need to know of medical situations that might require special consideration for thesafe conducting of Scouting activities.

In case of an emergency involving me or my child, I understand that every effort will be made to contact the individual listed as the emergency contactperson. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization,anesthesia, surgery, or injections of medication for me or my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for...