Troop 1 Broadmoor Boy Scouts

TROOP 1BOY SCOUTS OF AMERICA
PIKES PEAK COUNCIL
COLORADO SPRINGS, COLORADO

permission form

TROOP 1

BOY SCOUTS OF AMERICA

PIKES PEAK COUNCIL

COLORADO SPRINGS, COLORADO

[Scoutmaster carries this part for each Scout]

I, _____________________________, agree to let my son, ______________________________, participate with Troop 1 on the Falcon Trail Hike, 22 April, 2006. The person to be contacted in case of emergency or for significant changes to the planned itinerary is:

_____________________________________________________________________________________

Primary Contact Relationship Phone(s)

_____________________________________________________________________________________

Address

_____________________________________________________________________________________

Alternate Contact Relationship Phone(s)

_____________________________________________________________________________________

Address

In case of emergency I understand that every effort will be made to contact me. In the event I cannot be reached, I give permission to the physician named by me or the physician selected by the Troop 1 adult leader(s) to hospitalize and secure proper treatment (including surgery) for my son. I also give permission for my son to participate actively in the total activity program except as noted:

_____________________________________________________________________________________

Signed___________________________________________________________ Date _______________

emergency information

This Scout is highly allergic or sensitive to ___________________________________________________

What, if any, medication is this Scout taking __________________________________________________

Any special instructions for this medication? __________________________________________________

_____________________________________________________________________________________

Do you want the unit leader to carry the medication? Yes ______ No ______

Date of the latest or last tetanus shot/booster _________________________________________________

MEDICAL INSURANCE INFORMATION: Company ____________________________________________

Policy Number (or Control No. if group policy) _________________________________________________

Use the space below for additional information and for explanation of any other problems the activity unit leader should be aware of: _______________________________________________________________

_____________________________________________________________________________________

The suspense for this trip is the Troop meeting on Monday, 17 April – Please

have your permission slips in for this activity at this time.

SCOUT

COVENANT NOT TO SUE

(For participants who are younger than 18)

I, _________________________________, do hereby certify that I am the legal parent/guardian

of ________________________________________, who is voluntarily participating in boy/girl

scout-sponsored activities at the United States Air Force Academy. I understand that participation in this program involves the risk of injury and property damage. I understand and agree that I am assuming the risk of any personal injury that may result to the above named child while participating in the above-referenced activities, and in consideration for his/her participation in this program, I, for myself, my heirs, administrators, executors, and assignees, hereby covenant and agree that I will never institute, prosecute, or in any way aid in the institution o prosecution of any demand, claim, or suit against the United States Government and/or its officers, agents, or employees, acting officially or otherwise, in either my own capacity or that of guardian of the above-named child, or any injury to the above-named child which may occur from any cause whatsoever as a result of his/her participation in this program.

The term United States Government as used herein includes any officer, agent, or employee of the United States Government acting officially or otherwise.

________________________ ____________________________________

Date Participant

________________________ ____________________________________

Troop Number Parent/Guardian’s Signature

____________________________________

Dates of Event

_____________________________________________________________________________________________

ADULT

COVENANT NOT TO SUE

(For participants who are 18 and older)

I, _______________________________________, am voluntarily participating in boy/girl scout-sponsored activities at the United States Air Force Academy,. I understand that my participation in this program involves the risk of injury and property damage. I understand and agree that I am assuming the risk of any personal injury that may result while participating in the above-referenced activities, and in consideration of participating in this program, I, for myself, my heirs, administrators, executors, and assignees, hereby covenant and agree that I will never institute, prosecute, or in any way aid in the institution or prosecution of any demand, claim, or suit against the United States Government and/or its officers, agents, or employees, acting officially or otherwise, for any injury which may occur from any cause whatsoever as a result of my participating in this program.

The term United States Government is used herein includes any officer, agent, or employee of the United States Government acting officially or otherwise.

________________________ ____________________________________

Date Participant’s Signature

________________________ ____________________________________

Troop Number Dates of Event

[Scoutmaster carries this part for each Scout]

	Troop 1 Boy Scouts Broadmoor, Colorado Springs "Sponsored since 1981 by St Paul Catholic Church"
Home Calendar Activities Rosters Leadership Guidance Program Handbook 2006 Court of Honor Forms & Applications Adult Training Merit Badge Counselors Parents & Committee Meetings Photo Gallery	TROOP 1BOY SCOUTS OF AMERICA PIKES PEAK COUNCIL COLORADO SPRINGS, COLORADO permission form TROOP 1 BOY SCOUTS OF AMERICA PIKES PEAK COUNCIL COLORADO SPRINGS, COLORADO [Scoutmaster carries this part for each Scout] I, _____________________________, agree to let my son, ______________________________, participate with Troop 1 on the Falcon Trail Hike, 22 April, 2006. The person to be contacted in case of emergency or for significant changes to the planned itinerary is: _____________________________________________________________________________________ Primary Contact Relationship Phone(s) _____________________________________________________________________________________ Address _____________________________________________________________________________________ Alternate Contact Relationship Phone(s) _____________________________________________________________________________________ Address In case of emergency I understand that every effort will be made to contact me. In the event I cannot be reached, I give permission to the physician named by me or the physician selected by the Troop 1 adult leader(s) to hospitalize and secure proper treatment (including surgery) for my son. I also give permission for my son to participate actively in the total activity program except as noted: _____________________________________________________________________________________ _____________________________________________________________________________________ Signed___________________________________________________________ Date _______________ emergency information This Scout is highly allergic or sensitive to ___________________________________________________ What, if any, medication is this Scout taking __________________________________________________ Any special instructions for this medication? __________________________________________________ _____________________________________________________________________________________ Do you want the unit leader to carry the medication? Yes ______ No ______ Date of the latest or last tetanus shot/booster _________________________________________________ MEDICAL INSURANCE INFORMATION: Company ____________________________________________ Policy Number (or Control No. if group policy) _________________________________________________ Use the space below for additional information and for explanation of any other problems the activity unit leader should be aware of: _______________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ The suspense for this trip is the Troop meeting on Monday, 17 April – Please have your permission slips in for this activity at this time. SCOUT COVENANT NOT TO SUE (For participants who are younger than 18) I, _________________________________, do hereby certify that I am the legal parent/guardian of ________________________________________, who is voluntarily participating in boy/girl scout-sponsored activities at the United States Air Force Academy. I understand that participation in this program involves the risk of injury and property damage. I understand and agree that I am assuming the risk of any personal injury that may result to the above named child while participating in the above-referenced activities, and in consideration for his/her participation in this program, I, for myself, my heirs, administrators, executors, and assignees, hereby covenant and agree that I will never institute, prosecute, or in any way aid in the institution o prosecution of any demand, claim, or suit against the United States Government and/or its officers, agents, or employees, acting officially or otherwise, in either my own capacity or that of guardian of the above-named child, or any injury to the above-named child which may occur from any cause whatsoever as a result of his/her participation in this program. The term United States Government as used herein includes any officer, agent, or employee of the United States Government acting officially or otherwise. ________________________ ____________________________________ Date Participant ________________________ ____________________________________ Troop Number Parent/Guardian’s Signature ____________________________________ Dates of Event _____________________________________________________________________________________________ ADULT COVENANT NOT TO SUE (For participants who are 18 and older) I, _______________________________________, am voluntarily participating in boy/girl scout-sponsored activities at the United States Air Force Academy,. I understand that my participation in this program involves the risk of injury and property damage. I understand and agree that I am assuming the risk of any personal injury that may result while participating in the above-referenced activities, and in consideration of participating in this program, I, for myself, my heirs, administrators, executors, and assignees, hereby covenant and agree that I will never institute, prosecute, or in any way aid in the institution or prosecution of any demand, claim, or suit against the United States Government and/or its officers, agents, or employees, acting officially or otherwise, for any injury which may occur from any cause whatsoever as a result of my participating in this program. The term United States Government is used herein includes any officer, agent, or employee of the United States Government acting officially or otherwise. ________________________ ____________________________________ Date Participant’s Signature ________________________ ____________________________________ Troop Number Dates of Event [Scoutmaster carries this part for each Scout]