BSA TROOP 130, MAYNARD, MA

SCOUT ACTIVITY PERMISSION FORM

Activity: / Freeze-Out/New Scout Recruiting
Where: / Maynard Rod & Gun Club, Maynard, MA.
Drop Off: / Saturday, January 6, 2007 at 9:00 a.m. Maynard Rod & Gun Club, (Old Mill Road off of Waltham Street).
Pick Up: / Sunday, January 7, 2007 at 10:00 a.m. at the Rod & Gun parking lot.
Cost: CASH / $9.00 per youth and $11.00 per adult - Cash payments only. NO CHECKS

Special Note:

/ If you are arriving late on Saturday because of skiing or snowboarding lessons, please let Mr. Arntzen or Mr. Collins know at sign-up.

Due Date:

/ No later than Tuesday, January 2, 2007 Troop Meeting.

One of the true tests of a Scout/Venturer’s skills is a winter camping experience. Participants in the Freeze-Out receive this opportunity as well as the chance to polish their outdoors skills in a cold weather environment. Snow-permitting, we will go sledding at a great sledding site next to the Rod & Gun. Help recruit new scouts by inviting them to join us sledding on Saturday afternoon. We sleep in tents this trip and may hike from Stow to Maynard on Saturday morning. To insure each Scout/Venturer is adequately prepared, it's important they attend the meeting January 2. We’ve never had a Scout/Venturer who hasn’t been proud to say they survived a Freeze-Out. Parents are responsible to drop off and pick up their child at the Maynard Rod & Gun parking lot at the appointed times.

(DETACH HERE - KEEP TOP PORTION FOR YOUR INFORMATION)

Freeze-Out Permission Form – January 6 and 7, 2007

Although all participants in this activity are supervised, your written permission is required for your Scout/Venturer to attend. Your Signature relieves Troop 130 and its adult leaders from any liability in the event of an accident.

I give my child, / (please print full name), permission to participate

in the Freeze Out Camping Trip, Maynard Rod & Gun Club, Maynard, MA on Saturday, January 6 and Sunday January 7, 2007, and a 5-mile hike. I relieve Troop 130 and its adult leaders of any liability beyond normal supervision. I also give permission for my child to receive emergency medical treatment at the nearest hospital, first aid station, or other medical facility in case of an accident or serious illness.

Parent/Guardian Signature: / Date:

Troop 130 has your child’s Medical Data and Emergency Contact information on file. Has any of the following information changed recently?

Yes No Yes No

Emergency Contact Name or Phone [_] [_] Health Insurance Policy [_] [_] Medications, Allergies, or Medical Condition [_] [_] Family Physician (primary care) [_] [_]

If YES, provide the new information:______

Please note all medications your child will need during this trip must be provided to the Scoutmaster in an original prescription container at the time he is dropped off. This container will be returned to you at the end of the trip.

Medication: / Dosage: / x / a day.

Does your child have epilepsy, fainting spells, ear infections, asthma, bee sting allergy or any other chronic illness that we should be aware of during this trip? Please describe.

Parent Participation – To run a quality program, we need the assistance of every Scout’s family.

Name of Parent Attending: