Baltimore Area Council/Boy Scouts of America/National Pike District
I give my permission for my son/s / ward/s listed below to attend the following activity:
Backpacking trip on the Appalachian Trail
On the following dates: 25-27 April 2003
I have read and understand the information about this activity, I agree to pay the fees listed and to drop off and pick up my son/s / ward/s at the times and places indicated. My son/s / ward/s will bring the equipment and clothing indicated in the activity information sheet/s.
The following information is provided to assist in the planning of this trip:
Youth attending: ________________________ Fee $15.00 Patrol ___________
Youth attending: ________________________ Fee $15.00 Patrol ___________
Youth attending: ________________________ Fee $15.00 Patrol ___________
Adult attending: ________________________ Fee $15.00
Adult attending: ________________________ Fee $15.00
$_______________ Paid by: check ( ), cash ( ), credits ( ), IOU ( ).
Family Health Insurance Co/Policy # ______________________________
Parent Emergency Phone Number (______)______________________
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 son/ward on this activity, I hereby agree to his participation and waive all claims against the leaders of this trip and officers, agents, and representatives of the Boy Scouts of America. I also agree to accept financial responsibility for any loss or damage to property, which may be caused by the above named scout.
______________________________ __________
Signed (Parent/Guardian) Date
____ I cannot help with transportation. ____ I plan to take the following people with me:
____ I can drive to ( ), from ( ), the activity. ________________________________________
____ I have a car ( ), van ( ), truck ( ) ________________________________________
_________________________________________
I can carry myself, and ____ passengers not listed above.
My son/ward may need or needs to take prescription or other medications while at this event. I will give this medication to an adult leader with instructions and authorize the troop’s adult leaders to administer those drugs. Medication(s) ____________________________________
Signed: __________________________________ Date: __________
