BSA Troop 800 Permission Sheet

Print (2) of this form, 1 for your records and a signed 1 to turn in to the Troop Leader

Activity:

Activity Leader: Ph:
Asst. Activity Leader: Ph:

Cost and Transportation Arrangements

Time/Place for Departure:
Time/Place for Return:
Cost per Scout: Uniform:
What to Bring:

Other / Special Items:

RETURN THIS PORTION TO ACTIVITY LEADERS.
ONLY SCOUTS WITH SIGNED PERMISSION SLIPS MAY PARTICIPATE!!!
My son has permission to participate in the following activity:
He is in good health and may engage in all activities: Yes No . (If no, please list exceptions)
During the activity, I may be reached at: Phone:
If I cannot be reached in the event of an emergency, the following person is authorized to act in my behalf:
Name: Phone: Relationship:
Physician’s Name: Ph:
Date of last Tetanus:
My son has my permission to be given the following medication if needed:
TYLENOL 500 Mg. YES NO
DRAMINE 25 Mg, YES NO
ANTI-DIARRHEAL 2 Mg. (LOPERAMIDE - HCL) YES NO
Additional remarks, allergies or special medical consideration regarding my son:

UNIFORM SHIRT MUST BE WORN WHEN TRAVELING TO AND FROM THE ACTIVITY. LAYERS AND LONG PANTS ARE REQUIRED. NO ELECTRONICS ALLOWED. ADULT LEADERS WILL HAVE CELL PHONES.

In case of emergency, if none of the above can be contacted, I consent to treatment for my son under the supervision of and as deemed advisable by a physician licensed under the Medicine Practice Act. This provides authority pursuant to Section 25.8 of the California Civil Code.

The minor has my permission to travel to ____________________________ with Troop 800 to participate in the above activity.

Parent or Legal Guardian’s Signature: _______________________________ Date: _____________ Ph:_____________.