Troop 105, Travel/Event Participation Permission Form and Driver Info Form

From: David Skolnick
To: Troop 105 Parents and Scouts
Cc: Mike O'Melia
Subject: Troop 105, October 2007, Campout Info, Permission Slip, and Driver Info Slip

Greetings Parents and Scouts,

For the October 2007 campout, Troop 105 will travel to Windblown XC ski area (New Ipswich, NH, 603-878-2869) to enjoy the Cranberry Harbors Fall camporee program offered by Cranberry Harbors District of the Old Colony Council. Visit http://www.campsquanto.net/ to view the camp and visit http://cranberryharbors.r8.org/ learn more about the program. Or visit, http://www.windblownxc.com/ to learn more about the camping area.

Campout Information:

RESPONSE REQUIRED: Completed Permission Slips and Driver Info Slips are due back by Monday, October 15, 2007 (at Troop meeting).Please give your forms to our Camping Coordinator, Doug Lyons (or designee).

WHAT: Trip to Windblown XC ski area to enjoy the Cranberry Harbors Fall camporee program (hiking in the White Mountains); tents, suitable hiking shoes, warm cloths/sleeping gear required

WHEN: Friday, October 19, 2007 to Sunday, October 21, 2007

WHERE: Windblown XC ski area, New Ipswich, NH

TIMES: Meet at Pembroke center CVS parking lot to load vehicles at 5:30pm, Friday, October 19, 2007. Depart from Pembroke at 5:45pm. Pickup scouts from Pembroke center CVS parking lot at Sunday, October 20, 2007 at 12:00pm .

ACTIVITIES: The mountain hiking (5-6 miles) program run by Cranberry Harbors District volunteers

MEALS: Patrols (including the combined Senior patrol and Adult leaders) will plan their meals for this weekend. Scouts/Leaders must bring their own mess kits. The Troop will provide a common wash station for cleanup.

COST: $18 per person includes campsite and food, payable when submitting the permission form. Patrol leaders will be reimbursed $12 per person eating with their patrol. Budget food purchase accordingly.

CONTACT INFORMATION DURING EVENT: David Skolnick, cell phone, 781-856-5884

CONTINGENCIES: Severe weather may require rescheduling.

Permission Slip:

Scout/Adult Name Age

Address

Participant Itinerary Information:

Unless otherwise noted below, it is assumed that all scouts and adults will be:

Departing from Pembroke with the troop,
Eating all meals with the troop,
Participating in all planned activities, and
Returning to Pembroke with the troop.

Personal (Exceptions To Group) Travel Itinerary:
Late Arrivals Arrival Date Estimated Arrival Time

Early Departures Departure Date Estimated Departure Time

Other

**Personal (Exceptions To Group) Travel Itinerary:**
Late Arrivals Arrival Date		Estimated Arrival Time
Early Departures Departure Date		Estimated Departure Time
Other

Note: Any changes to Scout(s) personal travel itinerary, unless documented on this permission slip for this event, must be communicated to the Camping Coordinator, Committee Chairman, or Scoutmaster.

In case of emergency, notify:
Name: Relationship: Parent/Guardian

Address:

Home Phone: Cell Phone:
Other Instructions:

Med. Ins. Plan: Policy #:

**In case of emergency, notify:**
Name:	Relationship:	Parent/Guardian
Address:
Home Phone:	Cell Phone:
Other Instructions:
Med. Ins. Plan:	Policy #:

Have or is subject to (check if yes):
Asthma Fainting Convulsions Diabetes Heart Cond.

Allergies List:

Medication Reactions List:

Condition/Medication(s) List:

Activity Restrictions Describe:

**Have or is subject to (check if yes):**
Asthma	Fainting	Convulsions	Diabetes	Heart Cond.
Allergies	List:
Medication Reactions	List:
Condition/Medication(s)	List:
Activity Restrictions	Describe:

For adults/leaders, indicate most recent training date for BSA Youth Protection Training. ____/____/________

Parent authorization to be signed by parent of those under 18 years of age:

I give my son permission to participate in the planned trip to Windblown XC ski area and hike in surrounding area in New Ipswich, NH and to participate in the Cranberry Harbors District camporee program to be held there from Friday, October 19, 2007 to Sunday, October 20, 2007. The person herein described has my permission to engage in all prescribed activities except as noted by the physician and me. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the adult leader in charge to hospitalize, secure proper anesthesia, or to order injection or surgery for my son.

Name (print) Relationship (circle one): Parent/Guardian

Signature Date

Driver Info Slip:

(Drivers need to complete both the driver info slip and provide their information on the permission slip.)

I, ________________________________________ (Adult/Leader) will be able to drive ______ (number of scouts) either (circle one) To or From or To-and-From this event.

BSA Tour Permit Info
Driver's License Number State

Vehicle Make and Model Year

Vehicle Registration No. State

Passenger Capacity

Liability Ins. Amount/Accident Liability Ins. Amount/Passenger

**BSA Tour Permit Info**
Driver's License Number		State
Vehicle Make and Model		Year
Vehicle Registration No.		State
Passenger Capacity
Liability Ins. Amount/Accident		Liability Ins. Amount/Passenger

Driver's Pledge
I will follow the BSA guidelines for safe driving, and I will make sure that all occupants of my vehicle wear seat belts at all times while in my vehicle.
Name (print) Vehicle (circle one): Owner/Leasee

Signature Date

Name (print)		Relationship (circle one):	Parent/Guardian
Signature		Date