BSA Troop 209
CONSENT FORM 
Approval by Parent or Guardian


 
Scouts First Name(s)                                    Last Name                                         Birth Date(s)


Street Address                                      City                             State                         Zip            


Has MY CONSENT to attend         South Western Ohio Conservation Club (Cleves, Ohio)                               
                                                        
 On the following DATES/TIMES:


 Drop-off:  _Friday, May 10   at   4:30 PM        Pick-up:   Sunday, May 12    at  10:00 AM                                        
            *Note: unless otherwise noted, drop-off and pick-up is at Madeira Silverwood Presbyterian Church.
 
TRIP COST:  # of Scouts ______ x $ 15.00   incl food, camping & shooting            =  $ ___________


# of Adults  ______ x $ 0.00   incl food, camping & shooting              =  $ ___________
      
                                                                                     Total Remitted    =  $ ___________


**Scouts & Adults responsible for brown bag dinner on Friday evening.


PAID BY:    Please Select One -      Check _____ Cash ______Mulch_______


   
TRANSPORTATION:   I can____   OR  I cannot_____ drive  to ____ from ____both ways_____.


In doing so I can take _____ Scouts in my ___________________________ (type of vehicle).     


                           
                                                        Hold Harmless Agreement
I understand that participation in Scouting activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and have given consent for myself or my child to participate in this activity. I also understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.


In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities. 


Please Print Scouts Name________________________________________________________________


Parent/Guardian Signature___________________________________________Date_________________


Parent/Guardian Phone (____) ________________________Cell (____)___________________________