Consent form

CONSENT FORM
APPROVAL BY PARENTS OR GUARDIANS

__________________________________________________________________________________________ First name of BSA member/guest and middle initial __________________________________________________________________________________________ Address Birth __________________________________________________________________________________________ City (____)________________________________________ (____)________________________________ Area Code and telephone No. (parent’s business) APPROVAL
FOR:__________________________________________________
ON:__________________________
(Name of activity, orientation flight, outing, trip, etc.)
Parent / Guardian Signature______________________________
Date____________________
PARENTS OR GUARDIANS
(Please read all statements before giving approval for participation in the activity listed above.) I hereby approve and agree to all terms,
conditions, and waiver of claims of the CONSENT FORM and certify to its correctness. Further, I agree that this BSA youth member
or guest can meet the health and physical fitness requirements of the trip or activity.
Waiver of Claims
Medical Release
Scout/Venturer Driver Qualifications
In consideration of the In the event of illness or injury while involved in this trip or activity, I consent event under the leadership of an adult tour to X-ray examination, anesthesia, and/or medical or surgical diagnostic Scout/Venturer at least 16 years of age may America, pack, troop, necessary in the best judgment of the patrol, team, crew and attending physician and performed by or (1) six months’ driving experience as a under the supervision of a member of the medical services. It is understood that in the event of a serious illness or injury, conduct of their affairs, Policy number___________________ Notary Public (if required)
Water Activities
In the event that the trip or activity takes lace in total or in part on or near water, preliminary training and ____ Non-swimmer within the safety guidelines as may be appropriate. From the Guide to Safe Scouting – 2004 Printing Name:___________________________________________________________ Update for each activity: Day camp, overnight hike, or programs not exceeding 72 hours, with level of activity similar to that of home or school. Medical care is readily available. Current personal health and medical summary (history) is attested by parents to be accurate. This form is to be filled out by all participants and is carried on the activity for easy reference.
The following over-the-counter medications might be available from the crew first aid kits. Please
signify your authorization by initialing each space for the adult leaders to provide these
medications to your son based on need and/or their judgment or, if appropriate, whether your
permission is granted for your son to carry medications for self-administration.
Medication
Medicate
(Brand names are listed only for illustration - generics or other brands might be used) Please list any medications that you will provide. ______________________________ ____________________________________________ Printed Parent's Name Health Comments: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________ From the Guide to Safe Scouting – 2004 Printing

Source: http://www.bsa-troop462.org/documents/consentform.pdf