Pack 2146 Ct Science Center Campout 2019
10/18-20/2019
Email address *
Trip Information:
Activity *
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How many people from your family are you registering? *
Fill in name(s) of family members here. If you have multiple scouts in your family only one form is needed. If you are an adult leader with no other family members registering for the trip, just select 1.
Scout 1 First Name *
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Scout 2 First Name
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Scout 3 First Name
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Scout Last Name *
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List other people attending w/your scouts
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Parent/Guardian Name(s) *
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Home Phone *
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Cell Phone *
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Alternate Contact
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Alternate Contact Phone
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List additional information here
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Acknowledgement *
As the parent or legal guardian of the above named scout(s) I hereby give my permission for my scout(s) to participate in the above-mentioned activity. I give permission to the leaders of the above unit, to render first aid to my scout(s) or myself, should the need arise. In the event of an emergency, I also give permission to the adult leader in charge, to secure proper medical treatment for my scout(s) or myself, and for the medical provider(s) so selected to hospitalize, secure proper anesthesia, order injection, or secure other medical treatment, as needed. I further agree to hold the above named unit 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. I will carry a copy of the BSA Medical Form A and B in my possession for each member attending and/or give a copy to the trip leader. (Trip Leader: Brian Colton, 845-608-4792. Hudson Valley Council, Rockland District, Pack 2146)
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