_____________________________________________ has my permission to participate in

_____________________________________________ with members of Boy Scout Troop 52,

Swansea, Illinois from ______________ through __________________.

                                   (Day/Month/Year)                         (Day/Month/Year)

In the event of an emergency (and in the event that a parent/guardian cannot be reached) I give my permission for my child to be treated by medical personnel at the nearest medical facility, or by Scout Leaders for minor medical incidents. Furthermore, I hereby release Scout Leaders from responsibility for injuries or illness resulting from misconduct or disobedience of my child and/or other incidents resulting from situations or conditions beyond the Scout Leaders’ control.

I also acknowledge that my child understands that the Scout Leaders of Troop 52 are responsible for his or her safety and will set rules and policies to ensure a safe environment throughout the event.

My child has no illness and requires no medication EXCEPT as indicated below.

Medical Exception Info: __________________________________________________________

______________________________________________________________________________

Application of Medicine/Treatments (Continue on Reverse if Necessary): __________________

______________________________________________________________________________

Emergency Location/Phone Info: __________________________________________________

______________________________________________________________________________

I acknowledge that I have read this Permission Form in its entirety, that I understand it, and that I agree to be legally bound by its terms.

Parent/Guardian Signature: ____________________________________ ____________

                                                                                                                                                                        (Day/Month/Year)