Last Name ________________________ First Name ________________________

Patrol ________________________

Scout, _________________________________________, is authorized to participate in all Unit activities for the calendar year 2007-08, effective _______________________. I/We grant permission to participate on all Unit activities including those that are held at other than the regularly appointed meeting site and may involve driving to alternative locations. I/We understand that these activities can include but are not limited to overnight activities, water activities, off-trail hiking, rock and cave climbing, and fire and knife usage.

I/we authorize our Scout to participate in all Unit activities unless I/we inform the Unit Leader in writing prior to the activity. This authorization will remain in effect for said Scout while he is participating in any unit program or activity unless we revoke this authorization in writing and personally deliver the written revocation to the Unit Leader. I/we understand that is my/our responsibility to inform the Unit Leader of any current medical concerns not listed on the unit medical forms (i.e. ear infections, sinus infection, strained/pulled muscles, current or new medications, etc.) prior to an event. Should I/we choose not to have my/our Scout participate in any part of an activity, I/we agree to inform the Unit Leader in writing prior to the activity.

The troop will continue to issue Activity Notices for each individual outing or event, and may elect to collect activity-specific permission slips for record keeping purposes, but is not required to do so.

I/We understand that the Boy Scouts of America is an educational organization, membership is voluntary, and as such, reasonable precautions will be taken to insure the safety and well being of the Scouts during participation in the Unit activities.

In case of emergency, I understand that all reasonable efforts will be made to contact me. If I cannot be reached, I authorize the doctors and hospitals chosen by the registered adult leader to provide medical treatment, including any X-Ray examination, hospitalization, anesthesia, surgery, and medications by any licensed emergency personnel , medical practitioner or hospital.

My telephone: (Home) ______________________ (Cell) ______________________

Alternate telephone (name and #): ______________________

Medical insurance firm and policy number: _____________________________

Printed name of parent/guardian: ______________________________

Signature of parent/guardian: ______________________________ Date: _________