Cradle of Liberty Council, BSA

Troop 272 - Minquas District

<Trip Name Here>

Trip Destination:	<Name of campground/park etc.>
Departure:	<Include Date, time, location for departure> e.g.: Friday, Sept. 28, 2018 6:30 p.m. from the P.I.T. parking lot
Return:	<Include Date, time, location for departure> e.g.: Sunday, Sept. 30, 2018 approximately 1 – 3 p.m. at the P.I.T. parking lot
Cost:	(Make checks payable to: Rose Valley Troop 272, BSA)
What to Bring:	Personal gear for camping trip (sleeping bag, mess kit, etc.)
Optional:
What to Wear:
Daily Itinerary:	Hour-by-hour (if possible)
Destination:	Include name of destination, GPS Friendly address for drivers, and phone number for location
Information:
Questions:	Contact <Scout> at <phone#> or <Adult> at <Phone>
Emergencies	<Adult> can be contacted at any time during the trip on his/her cell phone: <Cell #> (if no answer, leave a message)

PERMISSION SLIP & MONEY ARE DUE ON <DAY>, <DATE>

TRIP PLANNING WILL OCCUR ON <DAY>, <DATE>

Attendance at Planning Meeting is required for all participants

Rose Valley Troop 272, BSA
Parental Permission
<Trip Name>

Trip Destination:	<Destination>

Dates:	<Dates>

Parent’s Consent and Agreement

I hereby grant permission for my son,	to participate in the above indicated trip. I agree that if, in the proper judgment of the adult leaders, my son is not acting in accordance with the promise below, that I will be responsible for removing him from the trip.

I hereby grant permission to the adult leaders to provide any medical care to the above-mentioned Scout from dd/mm/20yy to dd/mm/20yy that they deem necessary and proper in the case of an emergency. Also, I understand that I will be contacted at the earliest convenient time.

This document shall also serve as authority for any hospital and/or health care provider to render medical treatment to the above named Scout should treatment be deemed necessary by the medical staff of the facility or the adult leaders on the trip. I/We further agree to be completely responsible for any bills or payments that occur in providing medical care.

Parent’s Signature

Scout’s Promise

While on the above-mentioned trip, I promise to behave in a safe and responsible manner and to adhere to the Scout Law and Outdoor Code. I acknowledge that my parent(s) will be called to remove me from the trip if I do not keep this promise.

Scout’s Signature

Parent / Guardian Attendance And Transport

plans on attending and can transport	Scouts and their gear, have read the Troop’s Chaperone Policy and will abide by it during the entire trip.

By checking this box, I affirm that my BSA Youth Protection training and all required PA state background checks and clearances are current.

Signed

Scout Insurance Information	***Only If Changed***

Name

Medical Insurance Company
Policy #	Group #

Emergency Contact:	Name& phone #
Name & phone #

Please list any medication(s) that the Scout is currently taking and any allergies: