T88_PermisssionKD_08 by ajizai


									                                           BOY SCOUT TROOP 88
                                             San Francisco, CA

         Scout's Name:          __________________________________________________________

         Activity:            _March 1-2, 2008 – Klondike Derby, at Sunflower Preserve _________

                   This form must be completed and given to the adult leader for each activity.

         I understand that Troop 88, BSA, will provide adequate supervision for this activity and
         that every reasonable effort will be taken to ensure the safety of the participants. I agree
         that the Boy Scouts of America and Troop 88 cannot assume responsibility for accidents
         or loss of personal property. I therefore release Troop 88 from any claim that may arise
         out of this activity and specifically agree not to sue or bring any action against Troop 88.

         In case of emergency, I understand every reasonable effort will be made to contact me. In
         the event I cannot be reached, I hereby agree and give my permission to the physician
         selected by the adult leader in charge to secure proper emergency treatment which may
         include hospitalization, anesthesia, surgery or injections of medication for my son until I
         release the adult leader from responsibility.

         I have read the above, understand it and agree to its content.

           _________________________________________                      Date _____________
              Parent or Guardian (Signature)

             Print Name

         Address: _______________________________________________________________

         Telephone: ________________________________

         Doctor’s Name: ______________________Phone: _____________________________

         Health Plan Name: ___________________Group No.: _________________________

         Identification No: __________________________

dcc3a63c-d92a-417b-9ffe-d0b6105af045.doc                                                      Revised: Sep. 25, 2012

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