Microsoft word - canoe trip permission slip

BSA TROOP 228
CAMPOUT / ACTIVITY NOTIFICATION
Black Canyon (Hoover Dam) to Nelson’s Landing – Colorado River Weather:
Times: Depart
DEPARTING 9am SHARP
See attached outing schedule (subject to minor adjustments) Also see Custom Map outlined in Google Maps (email sent with link location, please share as desired) Project Leader:
Phone: (cell) limited coverage in canyon $100 + food on the road money Register / Sign-up on Troop website at www.OxnardTroop228.org Emergency Notification :
Committee Chair: Angela Whitecomb
Scoutmaster: Jeff Zook
Phone: 805-218-5505
Phone: 805-824-3525
Time of Return Notification: We will have scouts call all parents for approximate arrival time: arrival time between 3 - 4 pm
Other Instructions /
 All scouts must be able to swim and have passed the BSA swimmer’s test. Comments /
 Boaters must be constantly alert for underwater and partially submerged
Misc Info:
hazards such as sandbars, rocks, glass, or snags on the river.
 The current varies from 3 – 5 knots depending on the area and amount of water  Electronic personal devices are incompatible with troop outing and therefore are not permitted. Only exception is travel to and from the event, although this is discouraged.  In the event of an emergency, every effort will be made to contact those listed as  Kayaking and Canoeing entails known and unanticipated risks which could result in injury. Every effort will be made to reduce those risks, but some risks simply can’t be eliminated without jeopardizing the essential qualities of the activity.  Risk include but not limited to: boat capsize, travel in remote areas, prolonged exposure to cold water and adverse weather conditions, hypothermia, slips and falls while hiking, and back injuries.  The registered adults on this outing have been trained to BSA requirements on Safe Swim Defense, Safety Afloat, First Aid, and Hazardous Weather Training. However, they are not infallible, unknown physical conditions of the participants, inadequate warnings or instructions, quickly changing weather and/or equipment malfunctions can always happen. Special Note:
BSA TROOP 228 - - CAMPOUT APPLICATION / PERMISSION SLIP
PLEASE READ AND COMPLETE THIS FORM CAREFULLY
My son _______________________________ has my permission to attend an off-site activity with BSA Troop 228 as described on the cover sheet to this permission form. PARENT AND SCOUT COMMITMENTS
By completing and returning this form to the project leader, you have made a reservation in your scout's name and have accepted responsibility to pay the associated fee. See the campout/activity notice for event fee amount! I have read the list of recommended personal gear ATTACHED. “Other Instructions” (and any attached checklist), and confirm that my scout will be properly clothed & equipped for this activity. I understand that the leaders cannot check each boy's pack before departure. The use of tobacco products by scouts, as well as the use of alcohol and/or illegal drugs by scouts and Scouters is
absolutely prohibited at all Scout activities. Scout’s initials ________
& Adult’s initials ________ LATE ARRIVAL -- EARLY PICK UP: DESCRIPTION AND NOTIFICATION:
EARLY PICK UP RELEASE (SIGNATURE AT TIME OF RELEASE):
MEDICAL AND EMERGENCY INFORMATION
In the event of an emergency, when I or a designated contact cannot be reached at the telephone number provided below, the senior registered adult leader at the campout (activity) is authorized to act in my behalf at his/her discretion. Unless I
have noted otherwise in the SPECIAL INSTRUCTIONS SECTION of this form, my son does not have any medical history
[conditions, diseases, allergic reactions, etc.] about which a physician would need to know in an emergency.
For minor conditions, I authorize the senior registered adult leader to administer the following brand-name drugs or their generic equivalent:
[please circle those for which you give permission and strike-out those for which you do not give permission]:
EMERGENCY PHONE:
MOBILE PHONE : (OPTIONAL)
ALTERNATE EMERGENCY POC (OPTIONAL):
RELATIONSHIP:
SIGNATURE

Source: http://oxnardtroop228.org/wp-content/uploads/2013/04/Canoe-Trip-Permission-Slip-Fillable-Form.pdf