Troop 12 Activity Permission Slip

Troop 12 Activity Permission Slip

Troop 12, New Lenox, IL | Rainbow Council, Boy Scouts of America
Please do not edit this section of the page. SEE INSTRUCTIONS BELOW...
Activity Name:
Activity Description:
Activity Coordinator:
Departure Date/Time:

MonthDayYear
DateHourMinutesAM/PM Option
Return Date/Time:

MonthDayYear
DateHourMinutesAM/PM Option
Camp Location:
Activity Location:
Adult Leaders:
NOTE: Unless otherwise indicated, all troop activities will depart from the United Methodist Church parking lot and will return to the Laraway Lanes Bowling Alley parking lot in New Lenox on the date and time listed above.

IMPORTANT: All scouts must wear a “Class A” BSA scout shirt while traveling. No Exceptions will be made.
INSTRUCTIONS: Click/Tap each section below to enter all of the required information. Click/Tap the SUBMIT button when completed.

PARTICIPANT INFORMATION
Scout #1:*

First NameLast Name
Allergies Medications Restrictions:
Scout #2:

First NameLast Name
Allergies Medications Restrictions:
Adult:

First NameLast Name
Youth Protection Up-to-Date

TRANSPORTATION SUPPORT
I can provide transportation:

TO the activityFROM the activity
Driver's Licence #:
Vehicle Make/Model:

MakeModel
Seatbelts:

AUTHORIZATION
Participation Waiver for Youth Listed Above
In consideration of the Benefits to be derived and since Boy Scouts of America (BSA) is an educational institution membership in which is voluntary, and having full confidence that every precaution will be taken to ensure the safety and well-being of my son/daughter on this activity, I agree to his/her participation and waive all claims against the leaders of Troop 12, parent volunteers, officers, agents, and representatives of the BSA, privately owned vehicle that has met the standards set in place by the BSA and that the vehicle is listed on the BSA tour permit.

Upon an emergency, illness or accident during the activity identified above, I understand every effort will be made to contact me. In the event that I cannot be reached in a timely manner, the troop or unit leader of the activity identified above has my permission to obtain, without delay, medical treatment as judgment of medical personnel dictates. Proper medical treatment may include hospitalization, anesthesia, surgery, or injections of medication for my son/daughter.

I also give permission for my son’s name and/or photograph to be used in the Troop’s website and or newsletter, in accordance with the Troop’s privacy website policy, which does not publish their last name. Furthermore, I understand that photographs may also be used in local, regional and/or national newspaper articles that may or may not use my son or daughter’s last name.
Name of Parent/Guardian:*

First NameLast Name
Parent/Guardian Email:*
example@example.com
Signature of Parent/Guardian:*

Clear
Signature(s) of Scout(s):*

Clear
Date Signed:*

MonthDayYear
Date
Emergency Contact #1 Name:*

First NameLast Name
Emergency Contact #1 Phone:*

Area CodePhone Number
Other Notes;
Should be Empty:

Troop 12 Activity Permission Slip

INSTRUCTIONS: Click/Tap each section below to enter all of the required information. Click/Tap the SUBMIT button when completed.