Venture Crew 90

Venture Crew 90

Shrewsbury, Pennsylvania

York-Adams = Area Council / Boy Scouts of America

Parental Permission Slip for Special Activities

To Parent / Guardian and the Leader:

&nbs= p; Written permission of parents or guardians may be required for an activity or serie= s of activities held at a time or place other than the regular meeting time and place.

VENTURE CREW 90 will attend: a camping trip at Broad C= reek Scout Reservation (Camp Oest)

LOCATION: Dublin, MD

&nbs= p; Departure: Friday, December 15, 2006 @ 6:00 PM at the Scout House=

&nbs= p; Return: &= nbsp; Sund= ay, December 17, 2006 @ 1:00 PM at the Scout House

&nbs= p; Transportation: Personal Vehicles

Leaders: &n= bsp; Steve Meyer / Joe Isch

Expenses: &= nbsp; $ 20.00 Includes Camp and Food

Each scout will need to arrive in Class A Uniform (Wear for insurance purposes!!)

Recommended Equipment: Class B uniform, bedroll, hiking boots, second set of shoes, extra socks, rain gear, toiletries, flashlight, canteen, warm clothes for cold.

** Incase of emergency, the leader will notify: Bethany= Meyer (717-235-0747) who will immediately attempt to notify the parents.

(Tear off and return bottom of for= m to crew leader)

My Child _________________________________ has permission to participate in the activities taking place at Broad Creek Scout Reservation, December 15 ̵= 1; 17with Venture Crew 90. He is in good physical condition and has not had any serious illness= or operation since his last health examination.

During the activity I= may be reached at:

Address: ________________________________________________ Phone: _________

If I cannot be reache= d in an emergency, the following person is authorized to act in my behalf:

Name and Address: ________________________________________ Phone _________<= /p>

Physician’s Nam= e and Phone Number _________________________________________

Additional Remarks / Special Needs: _________________________________________

Parent Authorization for Medical Emergency Treatment=

In case of medical em= ergency, I understand that every effort will be made to contact the parents or guard= ian of the child. In the event th= at I cannot be reached, I hereby give permission to the physician selected by authorized B.S.A. Crew 90 perso= nnel to hospitalize, secure proper treatment for, and to order anesthesia or sur= gery for my child as named above.

Signature of Parent o= r Guardian: ______________________________ Date: __________

Address: _________________________________________________ Phone: ________

I have been offered t= he opportunity to authorize emergency medical care as above set forth and declined to so authorize said eme= rgency medical care without my approval and accept such complications as may occur should said medical care be needed and unavailable due to my being unavaila= ble to provide same.

Signature of Parent or Guardian: _____________________________ Date: ___________=

Address: ________________________________________________ Phone: _________