Parental Consent Form
TRIP NAME: _______________________________ DATE(S):____________________
PARENT'S CONSENT & EMERGENCY FORM
In consideration of the benefits to be derived, and in view of the fact that the Boy Scouts of America is an educational organization,
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(s) ______________________________________ during this activity or trip, I hereby agree to his (their) participation and
waive all claims against the leaders of this activity or trip and officers, agents, and representatives of the Boy Scouts of America.
IN CASE OF EMERGENCY, I hereby give permission to the physician selected by the Unit Leader, ________________________
or his designee __________________________ to hospitalize, secure proper treatment for, and order injections, medications,
anesthesia, or surgery for my child named above. If I cannot be reached at either of the telephone numbers below, call _________________________________ at__________________________.
Date of last tetanus shot:________________________________________
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Signed________________________________________________ Date:________________________
(Parent or legal guardian)
Address:______________________________________________
______________________________________________
Telephone: (Home)______________________________ (Work)_____________________________
