Fillable Bsa Activity Consent Form And Approval By Parents Or Legal Guardian printable pdf download

Boy Scouts of America — Troop 7

B. S. A. Troop #7

PO Box 621

ACTIVITY CONSENT FORM AND

Scituate, MA 02066

APPROVAL BY PARENTS OR LEGAL GUARDIAN

This form is recommended for unit use to obtain approval and consent for Boy Scouts, and guests (if applicable)

under 21 years of age to participate in a troop or activity. This form is required for use with flying plans and

should be attached to the flying plan application.

Scout’s

______________

Name: ____________________________________ E Mail ______________________________ Cell Phone

Parent’s Information:

PLEASE PRINT

Name________________________________________________ Name ________________________________________________

Address ______________________________________________ Address ______________________________________________

City __________________________ State ____ Zip _________ City __________________________ State ____ Zip _________

Home Phone________________ Cell Phone ________________ Home Phone________________ Cell Phone ________________

Work Phone _____________________________ Ext _________ Work Phone _____________________________ Ext _________

E Mail _______________________________________________ E Mail _______________________________________________

Emergency Contact:

Scout’s Information:

Name________________________________________________ Date of Birth _____________ Age During Activity ___________

Address ______________________________________________ NOTES:

City __________________________ State ____ Zip ________

Home Phone________________ Cell Phone ________________

Work Phone _____________________________ Ext _________

E Mail _______________________________________________

Relationship __________________________________________

Approval is give for the scout / guest to participate in:

Activity:

Dates

Restrictions

Without restrictions

Single Activity

Consent

With restrictions

Approval is given for the scout / guest to participate in:

Activity:

All Activities for the calendar year

Dates

Restrictions

Without restrictions

Yearly Activity

Consent

With restrictions

Hold Har

mless Agreement

I understand that participation in Scouting activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding.

I have carefully considered the risk involved and have given consent for myself or my child to participate in this activity. I also understand that par-

ticipation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Boy

Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with

the activity from any and all claims or liability arising out of this participation.

In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my

permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery,

or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and

treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian,

and/or determination of the participant’s ability to continue in the program activities.

Participant’s Signature:

_____________________________________________________ Date: __________________________

Parent’s Signature:

_____________________________________________________ Date: __________________________

Printed Name:________________________________________________________________

FORM 03 (11/11)

CLEAR

Bsa Activity Consent Form And Approval By Parents Or Legal Guardian

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