Parent/Guardian Agreement for Activities/Camping

 

Scouts _x____ Sibling _n/a______ (Please check one)

 

Name   ____________________________________________________               Age______________                  

 

Address Street _______________________________________________________________________

 

Town________________________________________                                 State _______            Zip____________________

 

Event/activity: _________________________Location:  _____ ___________________                                  

 

Dates: From _________________       To: _____________________________________ 

 

Parent/Guardian Agreement

 

I the parent/guardian of the above named child understand that my child will be attending this scheduled activity/camping experience with my full knowledge and permission. He may participate in all activities programmed, except as I may stipulate in writing to the leader in charge. Further, if in the judgment of the Scout leadership in charge, it becomes necessary to send my child to a nearby hospital, physician or dentist for diagnosis or treatment, they have my full permission to do so. Therefore, I give my full permission for my child to participate in all activities except as I may excluded in writing and I give my full permission to the medical attendant in charge to hospitalize, secure anesthesia or to order injections or surgery for my child, should the need arise, and I as a parent/guardian, will assume full responsibility for such arrangements including payment of expenses incurred thereby, shall indemnify and hold harmless the Patriots Path Council, Inc., its servants, agents, volunteers, or employees from all and any liability with respect thereto.

 

Please check one:

________ I will pay expenses directly.

________ Such medical expenses would be covered under policy #  ________________________________

Written by_______________________________________________________________________________

For the period ______________________through_____________________.

 

Date of last tetanus shot_____________Known allergies/medication________________________________

 

Best if both parents sign:

Parent/Guardian name___________________Signature_________________________________ Date_____

 

Parent/Guardian name___________________Signature_________________________________ Date_____

 

Emergency Phone Numbers that Parent/Guardian can be reached during this event:_____________________

Our Troop will be @: