BSA TROOP 159

Herndon, VA

Outing Notice

Parental Permission/Waiver of Liability

TRIP TO: __________________________   SCOUTMASTER CONTACT: _______________________

DATE AND TIME OF DEPARTURE:

(Unless otherwise indicated, all trips leave from the Church parking lot Scouts should arrive early to allow time for loading equipment, etc.)

DATE AND TIME OF RETURN:

(Time of return is approximate. Boys will be dropped off at their homes, unless other arrangements are made.)

COST OF TRIP PER SCOUT:

LOCAL CONTACT PERSON DURING TRIP: _________ PHONE:

(Write this name and number down before returning this slip! It may be difficult to make immediate contact with Scouts, especially when hiking.)

Tear Off and Save Top Portion

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In consideration of the benefits to be derived, and in view of the fact the Boy Scouts of America is an educational institution, membership in which is voluntary, and having full confidence that every precaution will be taken ensure the safety and well being of my son(s)/ward(s), namely:

PRINTED FULL NAME OF EACH SCOUT IN YOUR FAMILY GOING ON OUTING PRINTED NAME OF ANY ADULT ATTENDING WITH YOUR SCOUT

on the activity named above, 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.

In the event of an emergency, the Scout leader has my permission to obtain treatment for our son/ward at the nearest hospital/doctor, at our expense, if our own doctor is not available. Our phone numbers where we can be reached is/are:

Home:

Signature of Parent or Guardian

Other:

Date

MEDICAL CONDITIONS/ALLERGIES/MEDICATIONS WHICH MAY REQUIRE SPECIAL TREATMENT:

NAME AND POLICY NUMBER OF FAMILY MEDICAL INSURANCE:

(The Troop has medical insurance to cover outings. The above information is requested to ensure no Scout will be denied treatment for lack of insurance.)

TRANSPORTATION: Extra drivers are needed for most trips. Minimum age for drivers is 21; minimum liability insurance required is $50,000/$100,000.

I WILL BE ABLE TO DRIVE TO [ ] FROM [ ] (Check both if attending and can drive round-trip)

TYPE OF VEHICLE/NUMBER OF PASSENGERS:

(The Transportation Committee will call to confirm drivers. Failure to obtain enough drivers may restrict the number of Scouts who can go on the outing.)

THIS FORM, PROPERLY COMPLETED, MUST BE RETURNED BY DATE OF DEPARTURE.