BSA TROOP 697 - ACTIVITY PERMISSION & MEDICAL UPDATE FORM

Dear parent or guardian:

Both portions of this form must be filled out completely prior to any group activity or outing that your Scout plans to participate in. Most importantly, please make sure that all questions in the medical section of this form are answered, especially any changes in medication or medical status. The information that you provide could be critical should a medical emergency arise for your Scout. Please Print.

For all outings:

• Do not take: Cell phones, electronic games, radios, iPods and mp3 players!
• Scouts may not attend outings unless they wear blue class B t-shirts
• Early or late departures MUST be cleared with trip captain(s).

_______________________________________ has my permission to participate in the

                        (Name of Scout)

_____________________________________scheduled for ______________________

                             (Activity)						(Date)

I approve of the leaders who will be in charge of this activity. In the event of a medical emergency involving my child/Scout, I give the leaders of this activity my permission to seek any medical services deemed necessary.

                                                                               ______________________________________________

                                                                                                       (Parent's Signature)

In case of emergency, please contact _______________________ at_________________

                                                                               Name)                       (Phone Number)

MEDICAL UPDATE

Health Care Provider____________________________________Telephone______________________

Current Medications:

       Name of Medication(s):_________________________________________________________________________________

       Dosing times of Medication(s)____________________________________________________________________________

Allergies:_________________________________________________________________________

Other pertinent medical information (List any behavioral or changing medical conditions):

_________________________________________________________________________________

_________________________________________________________________________________