As the parent or legal guardian of __________________________________________,

I hereby give my permission for him to participate in an outing with BSA Troop 1018.

Date: 6 - 8 Jun 2008

Location:  Marriott Ranch, Hume, VA

Time/Place of Departure:  7:00 p.m./DUMC

Time/Place of Return:  TBD (early afternoon)/DUMC

I give permission to the leaders of BSA Troop 1018 to render first aid, should the need arise. In the event of an emergency, I also give permission to the physician, selected by the adult leader in charge, to hospitalize, secure proper anesthesia, order injections, or secure other medical treatment as needed. I further agree to hold BSA Troop 1018 and its leaders blameless for any accidents that might occur during this outing except for clear acts of negligence or non-adherence to BSA policies and guidelines.

In case of emergency I can be reached by:

Phone: ________________________

Alternate: (i.e. cell, pager): ___________________________

If I cannot be reached, please contact:

Name: _______________________________________  At (phone): ______________________________

Medical Insurance Company: ____________________    Policy number: _______________

Signed: __________________________________________ Date: _____________

(Parent or guardian)

If you would like to pay for this campout with Scout Bucks check here: ¨

Can you provide transportation?          Going – yes/no         Returning – yes/no

Passenger capacity with seat belts (excluding driver):  ___________________

If your son will not be traveling with the group, please indicate schedule changes (e.g. arriving late, leaving early, etc) _________________________________________________

Other notes for troop leaders?  ___________________________________________