Parental Consent Form
Troop 40

Name: has my permission to attend the Troop 40, Shoquoquon District or Mississippi Valley Council BSA activities.

Camp out/event:

Method of payment: Cash Scout account Check

In the event that my child may require medical care and/or surgical care while involved in any portion of an event, and I am unable to be reached or time does not allow; I hereby give my consent to medical and/or surgical treatment to the most appropriate medical facility location or the location at the Scoutmaster or his designee's discretion, and to the doctor on call or his/her designee to provide said care upon the authorization of Scoutmaster Dennis Stewart of Burlington, Iowa. I do here by state said Scoutmaster will be held harmless eturnium for his decisions made in this authorization.

This consent will be in effect beginning and ending .

If parent(s) or legal guardian(s) are gone during this period of time, please list who should be contacted in case of an emergency.

Contact name_______________________________________

Street address________________________________City_____________State

Phone number______________________

Parent/Guardian Signature____________________________Date__________________

 

Complete this form. Print and return it to the Scoutmaster.