Scout: /

Initial here if you will not be attending the activity.

Return this form at the Sept. 28th troop meeting. / Do NOT fill out the rest of the form if you are NOT going.

St. Joseph Boy Scout Troop 272 Oct. Activity ~ Montauk, NY 15-17 October 2004

My signature below indicates consent to my son’s participation in the activities of Boy Scout Troop 272 while tent or cabin camping at the Trailblazer Camporee, Navy Pier, Montauk, NY on October 15th through 17th, 2004. I waive all claims against (release and hold harmless) the leaders of this trip, officers of the charter organization, agents, representatives of the Boy Scouts of America and the sponsor.
In the event of an emergency or serious injury or serious health problem I give my permission (per my signature below) for you to obtain medical treatment for my son from EMS personnel and/or at the nearest hospital, doctor, or medical facility at my expense. I further certify that the info I have provided on my son’s personal health history is correct to the best of my knowledge. Any information missing from personal health history or new or temporary health problem, activity restriction, and/or change of insurance provider is noted on this form.
I understand that all medications are to be turned over to the Scoutmaster in charge when I drop my son off and that I am responsible to request the return of medications when I pick up my son.

Scout

/ Phone number

Address

/ problem / restriction / change of health insurance info

emergency contact and/or phone number

/ If I am not at St. Joseph’s on Sunday, my son may get a ride home with the following people…
payment method for camping fee

cash bank check # / Parent signature
We always need parents to help transport scouts to and from the camp and parents to
camp with us as parent chaperones. Please check your availability and note it below.
  I am not available to help this time.
  I am available to drive scouts to camp on Friday at 5:30 PM. (travel takes around 2 hours)
  I am available to drive scouts back to St. Joseph’s on Sunday. (Pickup at 9:00 AM.)
  I am available to stay at camp on ð Friday / ð Saturday / ð Sunday. (time? ____ - ____)
  I am available to camp overnight on ð Friday / ð Saturday.
number of passengers including your son______plate number______ð I can tow the troop trailer.
vehicle make/model/year______ð I can fit extra gear in my vehicle.
(Driver & passengers are required to wear seat belts. Vehicles must be properly insured & equipped. Spot checks are conducted.)

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PLEASE RETURN ABOVE PERMISSION FORM AND QUESTIONNAIRE AT THE Sept. 28st TROOP MEETING.
Keep info below for your reference.
·  depart from St. Joseph’s northeast parking lot at 5:30 PM on Friday, 15 October 2004
·  return to same location at 11:00 AM on Sunday 17 October 2004
·  location of activity – Trailblazer Camporee, Navy Pier, Montauk, NY
·  activity fee is $20 – not refundable - includes facility fees, troop overhead, food
If you will be late or cannot attend activity, contact SPL before 4:00 PM on Friday.
After 4:00 on Friday contact ASM Keller at 428-6829.
FULL “CLASS A” UNIFORM IS ALWAYS REQUIRED FOR TRAVEL.
APPROPRIATE GEAR AND CLOTHING FOR DAY ACTIVITY AND NIGHT SLEEPING IS REQUIRED.