GREATER YOSEMITE AREA COUNCIL BOY SCOUTS OF AMERICA

TROOP 21

PARENT/GUARDIAN PERMISSION TO PARTICIPATE IN TROOP ACTIVITIES

January 1, _____ Thru January 31, _____

Current year Following year

Pursuant to California Civil Code Section 25.8

Pursuant to California Penal Code Section 12552

I, ________________________ the PARENT/GUARDIAN of ________________________ give my permission for him to attend ALL TROOP AND PATROL activities within the above year.

At the time of this signing, he is in good physical condition. If, at the time of activity, he is not feeling well or I am aware that he has been exposed to a communicable disease, then I will make sure that he does not attend.

FOR MEDICAL CONDITIONS, SEE ATTACHED FORM:

If, in the opinion of the adult in charge of the event, it becomes necessary, the leaders may give FIRST AID to my/our son or take him to qualified medical personnel for emergency treatment, yes / no. (If “no” write reason and signed statement giving release from liability and any alternate instructions on the reverse side.)

The undersigned does hereby authorize the Scoutmaster of Troop 21, Greater Yosemite Area Council, Boy Scouts of America or such substitute as he/she may designate, as agent for the undersigned, to consent to any X-rays, examination, anesthetic, medical, dental or surgical treatment and/or hospital care for the above minor which may be deemed advisable by, and rendered under the general or special supervision of, any qualified medical personnel licensed under the provision of medicine practice act, whether such treatment is rendered at the office or said qualified medical personnel, at a hospital, Scout camp or elsewhere.

This authorization will be in effect while the above minor is in route to or from, or involved or participating in, any troop activity or any activity of the Greater Yosemite Area Council, Boy Scouts of America, unless revoked in writing by the undersigned and delivered to the Scoutmaster of Troop 21.

In case of emergency, I can be reached at:

Home phone: _________________ Work phone: ________________ Cell phone: _____________

Pager #: _________________ Scout’s Birthday: ____________

Home address: _____________________________________________________________

Insurance Carrier: _____________________________________________________________

Policy #: ____________________ Primary insured: __________________________

Make/Model of vehicle: _______________________________ Year ___________________

Drivers License# ___________________ # passenger w/seat belts _____

Signed: ___________________________

If I cannot be contacted, please call:

Name: ___________________________ Phone#: ___________________

Address: ___________________________ Cell #: ___________________