Microsoft word - 2011 huntsville permission form

AUTHORIZATION, DISCLAIMER, CONTACT, MEDICAL This is to certify that Scout ___________________________ has my permission to attend the Troop campout to be held at
Huntsville State Park in Huntsville, TX on October 7-9, 2011 with members of Troop 1288. I herewith release the adult
leader and his assistants from any liability and any and all claims for injuries that might be received during this trip either at
the destination or in traveling to and from the said event. The adult leader or designated assistant has my permission to
secure medical help, if needed, for my child in the event of an emergency.
Please list any medical information appropriate for you Scout. The Scoutmaster in Charge needs to know any prescription
medication that your Scout is currently taking and any existing medical conditions. All medication needs to be given to the
Scoutmaster in Charge in the original container at departure site. Please list all medication to be taken during the activity:
As needed, the following medications with a check mark may be dispensed by the SMIC using the manufacturers’ directions: Parent(s) signature_______________________________ _________________________________ Date______________ While my Scout is attending this event, I can be reached at: Phone #(_____)_________________________ The Scout Fee for this event is $21.00 which includes:
$ 7.00 Camp Fee
$ 0.00 Food - troop provided
Meet at Epiphany
$ 11.00 Transportation Fee
Depart Epiphany
$ 3.00 Equipment & Consumables Fee
Depart Huntsville SP
Arrive Epiphany
I will be leaving with the troop: ______________ OR, I require a later departure time (TBD): ____________________
I can attend the activity if I can meet the Troop at the campsite on Saturday morning Will there be any change in Itinerary for Scout, if so please explain: ______________________________________________ Boy Scouts are expected to exemplify a higher level of personal discipline and social behavior than other boys and society in general. Scouts have agreed to strive toward the qualities listed in the Scout Law. Behaviors unworthy of a Scout and behaviors generally not acceptable in society will not be tolerated in Troop 1288. A first incident of improper behavior will result in the Scout calling home. Any further incidents will result in the scout being suspended from the event, and the Scout’s parent(s)/guardian will be called to come and pick up their scout from the event. Scout Acknowledgement of fee deduction & conduct ______________________________________________________ There is NO Adult Fee for this event.
Adults attending this event: ____________________________________. Departing with Troop? YES / NO Adult (circle one): BOTH WAYS / TO EVENT / FROM EVENT / NOT DRIVING.
Adult Signature__________________________________________Date_____________ Cell Phone # ( ____)____-_______ THIS PERMISSION SLIP MUST BE TURNED IN BY: September 27, 2011
Huntsville State Park Troop Campout
October 7-9, 2011
Receipt & Acceptance of Fees
Scout Behavior
Campout Itinerary
Assistant Scoutmaster-In-Charge: James Meredith
Tue Sep 27, 2011
Signed Permission slip and Scout Behavior Policy due. Fri Oct 7 5:00PM
Epiphany [Bring a Sack Dinner]
Fri Oct 7 5:30
Depart Huntsville
Sun Oct 9 12:30
Arrive Epiphany

Class A Scout Uniform must be worn at all times during the drive.
Patrols need to plan menus, assign a grubmaster to purchase food and supplies for 3 meals on Saturday and
breakfast on Sunday (Snacks Optional). Scouts should bring a brown bag dinner to eat on Friday evening.
This is also my receipt to acknowledge that the event fee of $21.00 may not be refundable in the event that
Scout is unable to attend the event. If you cancel, each activity and circumstance will dictate which if any of
the fees will be refunded as fees may have already been spent or committed towards the activity.
Examples of unexpected and unacceptable behavior include (but are not limited to) disrespect for authority
and insubordination of youth leaders, or adult advisors, actions that endanger the physical well-being of
others, physical or sexual abuse, mental abuse, profanity, dishonesty, antagonism or harsh criticism of others,
any unlawful behavior, and failure to adhere to Troop policies and procedure.



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