Permission Form

I give my son                                                          permission to go camping with Boy Scout Troop 205 to _________________ from ____________ to ____________ .

In the event of an emergency:

(1.) You can reach me at the following telephone number(s):                                

                                                                                      :                                

(2.) I authorize the Tour Leader or Assistant Tour Leader to obtain emergency medical treatment for my son.  My son is covered under the following health insurance information

Plan:                                 

Group:                                            

Id:                                       

My son has the following disability, which would impair his ability to participate in this trip

                                                   (if none please indicate). 

Allergies, Medications or other information that the Scout Leaders should be aware of:

Parent’s Name:                                                            

Parent’s Signature:                                                            Dated: