| TROOP 406 PERMISSION FORM Scout name__________________________________________ Scout activity_______________________________ Date_________________ I hereby grant permission for the above named scout to participate in the above Scout activity. I understand that every effort will be made to make contact with me if there is a problem during this activity. In the event that I cannot be reached, I hereby give permission to the physician/health care provider selected by the Adult Leader(s) of the activity to secure any necessary health care for him. I have discussed with the above named scout that he is to conduct himself in accordance with the Scout Oath and Scout Law at all times while on this activity. He understands that inappropriate behavior or language will not be tolerated. Scout signature_________________________________ Parent/guardian signature____________________________Date__________ Total number of people in family attending_________ Payment for activity $_______________per person Payment by (circle) check payable to BSA Troop 406 (amount__________) Cash (amount_______________) Scout account (amount______________) Parent is able to provide transportation Y/N__________ For total number of seats (with seatbelts)___________ Emergency phone numbers: home______________work______________ other (cell phone, etc)_________________ Medical insurance company and ID number (optional)________________ ________________________________________________________________ Allergies________________________________________________________ Medications_____________________________________________________ Restrictions on diet and/or activities_________________________________ |