Please register each person camping with a separate form.
TROOP 78 SPECIAL ACTIVITIES PERMISSION
Climbing At Slippery Falls
Slippery Falls Scout Ranch, Tishomingo, OK
Climbing, Fellowship, Food, and Fun
Departure Date and Time:
Meet at Church Friday, October 7, 2016 at 4:30 pm
Return Date and Time:
Sunday, October 9, 2016 at 12:30 pm
Contact At Site:
Dallas New (405) 812-1672
Contact in Edmond:
David Bailey (405) 850-4562
Cost: Scouts $30 Adults $10
Which MUST be paid at the Troop Meeting on October 3, 2016
Things to Remember:
Scouts and Adults should wear Class A (Field Uniform) to travel. Make sure to bring your scout book. Bring a sack dinner and drink with you.
Troop 78 has a no electronics policy on all campouts. I understand Troop 78 is not responsible for any phones or any electronics on a campout.
My Son, whose name is shown below, has my permission to attend the trip to the Troop 78 Climbing Campout, October 7-9, 2016. If the need for medical attention should arise, I give my permission to the leaders of Troop 78 to seek such treatment. If you are camping also please hit the back arrow and change your sons name to your name.
Name of Scout or Camping Adult
Scout's Patrol, or Adult
Will the Scout be traveling with Troop? OR Will the Adult be driving for the Troop?
All medications and dosage instructions must be given to the Scoutmaster before leaving on the campout. Be sure to place all medicines in a ziplock bag and label bag with scout's name and provide dosage information for each medicine.
My son named in the box above will be taking the following medication(s):
If you are driving to the campout, what is the total number of seatbelts in parent's car (This number includes the driver's seatbelt)
If you are driving to or from the campout, please answer the following questions.
Vehicle Make and Model that will be driven
Insurance Coverage (for example 100, 300, 100)
I may be reached at the following numbers:
Parent's Home Phone Number
Parent's Cell Phone Number
Parent's Other Phone Number
Additional Contact Person:
Additional Contact Name:
Additional Contact Relationship:
Additional Contact Phone Number
By checking the following box, I am giving the leadership of Troop 78 permission to seek medical treatment if needed for my son.
Parent's E-mail Address, you will receive a confirmation email at this address.
In the space below, please fill in the Parent / Guardian Name below: By submitting this form, I am electronically signing this form, giving permission to Troop 78 Leadership to seek medical treatment if needed for my son.
If you are paying for multiple Scouts and Scouters only fill out the PayPal payment box once.
If you fill out the PayPal payment info on the last registration you can just use the back arrow and change the names on the form.
If you are bringing a check to the Scout meeting please uncheck the box below in the Campout Payment (If using PayPal) and use 0 (zero) for the number of campers. You can pay with a credit or debit card by using PayPal.
If Paying by check or have already paid by PayPal for a previous attendee, uncheck the box below in the Campout Payment (If using PayPal) and type 0 in the box!
Campout Payment (If using PayPal) If registering multiple after the first person uncheck the box to the right, so you only go to paypal once.
Number of Campers
If you have problems or questions about this form please email Dallas New at firstname.lastname@example.org
This registration system is a ticket item for my Wood Badge Training Experience. I would appreciate any feedback you have about the online registration system. I thank you for your help in advance. Dallas New
Should be Empty: