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, November 2007, Campout Info, Permission Slip, and Driver Info Slip

Greetings Parents and Scouts,

For the November 2007 campout, Troop 105 will travel to Yawgoog Scout Reservation (Rockville, RI) to enjoy the camp tour and Klondike Derby practice program. Visit http://www.narragansettbsa.org/yawgoog to view the camp and learn more about the camping area.

Campout Information:

RESPONSE REQUIRED: Completed Permission Slips and Driver Info Slips are due back by Tuesday, November 6, 2007 (at Troop meeting). Please give your forms to our Camping Coordinator, Doug Lyons (or designee).

WHAT: Trip to Yawgoog Scout Reservation to enjoy the camp tour and Klondike Derby practice program; tents, suitable hiking shoes, warm cloths/sleeping gear required

WHEN: Friday, November 16, 2007 to Sunday, November 18, 2007

WHERE: Yawgoog Scout Reservation (Rockville, RI)

TIMES: Meet at Pembroke center CVS parking lot to load vehicles at 6:30pm, Friday, November 16, 2007. Depart from Pembroke at 6:45pm. Pickup scouts from Pembroke center CVS parking lot at Sunday, November 18, 2007 at 12:00pm .

ACTIVITIES: The camp tour (hike) and Klondike Derby practice program

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: $12 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 Yawgoog Scout Reservation (Rockville, RI) and to participate in the camp tour and Klondike Derby practice program to be held there from Friday, November 16, 2007 to Sunday, November 18, 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