UNIT

(Suggested)

Activity Authorization Form

 

I, the parent or legal guardian of ____________________________________________, acknowledge that I have been informed that he will be traveling by automobile, rental van, and/or passenger van to __________________________________________ on ___________, 20__, and that he will be returning on ______. I also understand that the planned activities include hiking for at least ____hours, and may include camping overnight. If this is a cold-weather campout all Scouts will need to be properly prepared in order to participate.

 

I hereby give my full consent and permission for this trip and to engage in all prescribed Boy Scout activities for this unit’s Camping Trip/Scout Outing. I understand the activities may be rigorous and that they may involve risk of serious injury. My son is in good physical condition and is fully able to participate in all prescribed activities. I have carefully considered the risks involved and agree to hold the Boy Scouts of America, Inc., Three Fires Council, BSA, BSA volunteers, and their respective officers, leader, agents representatives and employees harmless from all personal injury and illness arising out of, or resulting from, participation in such activities, including travel to and from such activities.

 

The health history of my son, set forth in the Class 1 Personal Health History, is accurate unless any modifications are indicated below:

 

In the event of illness or accident in the course of such activities, I request that measures be instituted without delay as the judgment of Scout leaders, volunteers and medical personnel dictates.

 

_____________                                  __________________________________________

            Date                                                           Signature of Parent and/or Legal Guardian

 

Home Phone: ___________________________

 

Alternate Phone: _________________________

 

Alternate Phone: _________________________ ( DB 11/23/02)