TROOP 21, BSA

TROOP 21, BSA

SAXONVILLE, MA

Scout Permission Form<= o:p>

Scout Me= dical Information

Scout's Name: ____________________________ Address: ____________________________

City: _Framingham_________ State: <= /span>MA Zip: 01701

Health/Accident Insurance Co: ___________________ &= nbsp; Policy Number: ________________

Has or subject to (check if yes):

Asthma: ___	Fainting: ___<= /o:p>	Convulsions: ___	Diabetes: ___<= /o:p>	Heart Trouble: ___<= o:p>	Bleeding: ___<= /o:p>
Allergy to plant, a= nimal: ___ Explain?	Allergy to medicati= on: ___ Explain?

Explain: _____________________________________________= _________________________

Any restriction of activity for medical reasons: _______________________________________

Parent M= edical Authorization

This health history is correct so far as I know, and t= he person herein described has permission to engage in all prescribed activiti= es identified on the next page, except as noted by me. In the event that I can= not be reached in an emergency, I hereby give permission to the physician, sele= cted by the adult leader in charge, to treat, hospitalize, secure proper anesthe= sia, or to order an injection for my son.

Name: _________________________________ &= nbsp; Date: ________________________

Signature: ______________________________

Home Telephone: ________________________ &= nbsp; Ce= ll Phone:____________________

Telephone Number of relative or neighbor: ___________________________

TROOP 21= , BSA

SAXONVILLE, MA

Scout Permission Form<= o:p>

Troop Ev= ents

Troop 21 Sc= hedule for 2007 - 2008

Month	Event	Month	Event
September	Shooting - Harvard Gun Club, = Harvard, MA	March	Biking – Callahan SP
October	Orienteering - Nobscot	April	Backpacking – Treas= ure Valley, Paxton, MA
November	History – Camp Pouch NYC, NY	May	Biking - Nantucket, MA
December	Indoor Rock Climbing – <= st1:place w:st=3D"on">Boulder Morty's, NH; Learn to Ski, NH	June	Kayaking – W. MA
January	Winter Survival/Skiing Camp Ma= cGregor, VT	July	Summer Camp - Resolute Award Pool Party
February	Sledding - Hemenway, NH	August	Troop Planning Meeting

Parent's Consent/Waiver

In consideration of the benefits to be derived, and in= view of the fact the Boy Scouts of America is an educational organization in whi= ch membership is voluntary, and having full confidence that every precaution w= ill be taken to ensure the safety and well-being of my son, I hereby agree to h= is participation and waive all claims against the leaders of these activities = or trips and officers and representatives of the Boy Scouts of America.

Name: ___________________________ = Date: ______________________________

Signature: ________________________