PERMISSION SLIP

 

TROOP 39 IS GOING TO ATTEND A WEEKEND CAMPING TRIP FROM DECEMBER 1ST THRU DECEMBER 3RD TO THE INDIANA SAND DUNES STATE PARK NEAR CHESTERTON INDIANA. WE WILL BE LEAVING APPROXMATLY 5:30PM. AND WILL RETURN ON SUNDAY AFTERNOON. WE WILL BE STAYING IN A HEATED BUILDING.

 

THE COST PER SCOUT WILL BE $20.00 AND WILL BE DUE ON NOVEMBER 22ND.

DRESS WARM, IT CAN BE VERY COLD IN DECEMBER. BRING A SACK LUNCH FOR FRIDAY EVENING.

 

PLEASE DETACH (AT THE DOUBLE LINE) AND RETAIN THIS SECTION. RETURN THE REST OF THIS FORM PROCEEDING THE DEPARTURE TIME.

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WAIVER OF RESPONSIBILITY

TROOP 39 BOY SCOUTS OF AMERICA

SPONSOR: BOLINGBROOK FIRE DEPARTMENT

 

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 TAKE TO ENSURE THE SAFETY AND WELL BEING OF MY SCOUT

SON (S) / WARD (S), NAMELY:

 

(SCOUT NAME) ____________________________________, MAY ATTEND TROOP 39’S WEEKEND CAMPING TRIP FROM DECEMBER 1ST THRU DECEMBER 3RD TO THE INDIANA SAND DUNES STATE PARK NEAR CHESTERTON INDIANA. WE WILL BE LEAVING APPROXMATLY 5:30P.M. AND WILL RETURN ON SUNDAY AFTERNOON. WE WILL BE STAYING IN A HEATED BUILDING.

 

THE COST PER SCOUT WILL BE $20.00. IT WILL BE DUE ON NOVEMBER 22ND AT OUR WEEKLY MEETING. DRESS WARM, IT CAN BE VERY COLD IN DECEMBER. BRING A SACK LUNCH FOR FRIDAY EVENING.

 

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.  IN THE EVENT OF AN EMERGENCY, THE TROOP UNIT LEADER OF THIS ACTIVITY, NAMED BELOW, HAS MY PERMISSION TO OBTAIN MEDICAL TREATMENT FOR THIS SCOUT, OR MYSELF IF ATTENDING, AT THE NEAREST HOSPITAL OR DOCTOR, AT MY EXPENSE, IF OUR OWN DOCTOR IS NOT READILY AVAILABLE.  ANY ADULT WHO SIGNS THIS FORM AND ATTENDS THE ABOVE OUTING AGREES TO THE ABOVE STATEMENT.

 

RICHARD L. WARD                                                                                       

(leader in charge)

 

_________________________________________________       DATE    ___/___/___

(signature of parent or guardian, or any adult attending the above outing) and date