BSA TROOP 73 Camporee Trip FORM
Part 1
TRIP DESCRIPTION Watchung Mountain District Wilderness Survival Camporee
DAY (S)/DATE (S) October 19, 2007 to October 21, 2007 LOCATION Round Valley
LEAVE FROM Watterson Street Parking Lot TIME 6:00 pm Friday
RETURN TO Watterson Street Parking Lot TIME Noon Sunday
COST: $45 - Includes Event Patch
COOKING BY: Patrol
UNIFORM REQUIRED: Class B Troop T - shirt
RELIGIOUS SERVICE: None
EMERGENCY CONTACT NUMBER AT TRIP SITE: John Korunow’s Cell Phone – 908-347-6430
SUGGESTED EQUIPMENT LIST
PERSONAL GEAR PATROL GEAR
____ PACK __x__ SLEEPING BAG w/stuff bag __x__ CAMERA
____ BOOTS __x__ FOAM PAD ____ HIKING STICK
__x__ SOCKS __x__ COMPASS ____
__x__ CLOTHING APPROPRIATE __x__ TOILETRIES ____
FOR THE SEASON __x__ MESS KIT
__x__ RAIN GEAR or PONCHO __x__ POCKETKNIFE
__x__ SWEATER or JACKET __x__ SMALL FLASHLIGHT
__x__ HAT w/ EXTRA BATTERIES
__x__ WATER BOTTLE __x__ SCOUT HANDBOOK
__x__ MOCCASINS or LIGHT SNEAKERS
Any special or additional information on this trip may be obtained by calling one of the following:
Adult Trip Coordinator: John Korunow Phone: 908-232-4388
Scout Trip Coordinator: ______Phone: ______
SPECIAL TRIP NOTES:
(This page to be kept by Scout.... next page must be turned in to Scout Trip Coordinator with the proper fee by the proper date)
(Revised 3/4/00)
REGISTRATION AND MEDICAL RELEASE FORM Part 2
This form must be turned in to Scout Trip Coordinator with proper fee on or before June 4, 2007
I (we) will be attending the ______Trip,
Scheduled for the Day(s) / Date (s) of: ______through ______
Scout (s) attending (1) ______(2) ______
Parent (s) attending ______Enclosed is $ ______.
MEDICAL INFORMATION
I (parent / guardian) recognize that under the best supervision, accidents may happen. In the event that my son (s) become injured or ill, I hereby grant to the Scout trip leaders, who, if unable to reach me in a reasonable length of time, may, at their discretion, admit my son(s) to a hospital for emergency treatment as determined by the physician in charge at the time.
My son (s) ______has / have my permission to participate on this trip. He is in good physical condition and has had no serious illnesses or operations in the last six weeks.
My son is allergic to the following foods, insect stings, medications, etc.
(Name of Scout)______is allergic to ______
My son is taking the following medication: ______Dosage ______
In the event of an emergency, I may be reached at the following phone number(s): home______
Work ______Cell Phone ______
My Insurance Company is: ______
My Insurance I.D. Number is: ______
Signature of Parent or Guardian ______
I WILL NOT permit the above medical treatment to be done under any circumstances!
Signature of Parent or Guardian ______
(Your son may still participate in the trip, but under these circumstances, a parent or guardian must accompany the Scout on the trip.)
(Revised 3/4/00)