My son has my permission to attend campout or activity listed. In granting this permission, I (we) waive all claims against Boy Scout troop 171, the Boy Scouts of America, or any of its leaders for any injury or illness my son may sustain during this outing.  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the adult leader in charge to hospitalize, to secure proper anesthesia, or to order appropriate injection or surgery for my son.

If I am involved in transporting Scouts on this outing, I will make sure that seat belts are provided for each passenger and driver.  I also represent that the vehicle I will drive has adequate insurance coverage.  (BSA requires $50,000/100,000 liability, $50,000 property damage).

In completing this form, I agree to all terms and conditions set forth in the BSA Medical Release Form on file with Troop 171.