PERMISSION SLIP
Waiver of Responsibility
Troop 336
BOY SCOUTS OF
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 Scout, namely: _____________________________ on the activity
named below, I agree to his participation and waive all claims against the
leaders of this trip, officers, agents, and representatives of the Boy Scouts
of America, and the sponsor, Saint John Lutheran Church. In the event of an
emergency, the Troop unit leader of the activity named below has my permission
to obtain medical treatment for this Scout at the nearest hospital or doctor,
at my expense, if our own doctor is not readily available, and as restricted on
the Emergency Data Sheet on file with Troop 336.
__________________________________________________
Signature of parent or guardian, and date
ACTIVITY:
EMERGENCY INFORMATION (IN
ADDITION TO PERSONAL HEALTH AND MEDICAL RECORD)
During the activity listed
above, I can be contacted at the following phone number.
(_______)__________________________
(_______)____________________________
If we are not available
call _______________________ relationship ____________________________
alternate phone # (________)
_______________________
This Scout is highly
allergic or sensitive to: ________________________________________________
What if any medication is
this Scout taking? _______________________________________________
Any
special instructions for this medication? _______________________________________________
Do you want the unit leader
to carry this medication? ________________________________________
Unit leader in charge of
this outing: Randy Showerman phone: 517-974-6904