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

From: Tony Winters (Manomet Chapter Chief) and John P. Feeney (Manomet Chapter Advisor)
To: Arrowmen of Manomet Chapter, Tisquantum Lodge, Order of the Arrow
Cc: Chris Marcus (Tisquantum Lodge Chief)
Subject: Manomet Chapter Fellowship Campout and Canoe Trip, May 29-31, 2009 , Campout Info and Permission Slip

Greetings Arrowmen, Parents, and Guardians,

For this year's Chapter Fellowship campout, Manomet Chapter will travel to Camp Squanto (Plymouth, MA) to enjoy the camping, fellowship, and a canoe trip on the Agawam river (adjacent to camp) .

Campout Information:

RESPONSE REQUIRED:

Completed Permission Slips for youth and adult Arrowmen are due by Monday, May 25, 2009.

Please submit forms by email to Tony Winters (tonywin@comcast.net) and John P. Feeney (j.p.feeney@comcast.net).

{Directions: Save this HTML file. Edit it with MS-Word or other program to add your info. Email the updated file.}

WHAT:

Trip to Camp Squanto (Plymouth, MA) to enjoy the camping, fellowship, and a canoe trip on the Agawam river (adjacent to camp); tents, suitable hiking shoes, warm cloths/sleeping gear, and water shoes/sneakers required.

WHEN / WHERE / TIMES:

Arrive at Lyons Nature Center Friday, May 29, 2009 (~7pm)
Depart from Camp Squanto parking lot Sunday, May 31, 2009 (~9am)

If your arrival and/or departure times differ, please let Tony and Mr. Feeney know!

MEALS / COST:

The meals and cost of this event are being completely funded by the money raised from the Cranberry Harbors MBU snackbar, which was run by the chapter. The Saturday evening meal is typically all-you-care-to-each Chinese dinner. Nobody goes home hungry from and O/A event.

CONTACT INFORMATION DURING EVENT:

Tony Winters, cell phone, 781-827-6128

CONTINGENCIES:

Severe weather may require cancelling/re-scheduling the canoeing excursion.

Permission Slip:

Scout/Adult Name Age

Address

Participant Itinerary Information:

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

Arriving at the Lyons Nature Center (Camp Squanto) on Friday, May 29, 2009 (~7pm),
Eating all meals with the chapter,
Participating in all planned activities (games, short hike, and canoeing day trip), and
Departing from the Camp Squanto parking lot on Sunday, May 31, 2009 (~9am).

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 Chapter Chief or Chapter Advisor.

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 Camp Squanto (Plymouth, MA) to enjoy the camping, fellowship, and a canoe trip on the Agawam river (adjacent to camp) and to participate in the Manomet Chapter Fellowship program to be held there from Friday, May 29, 2009 to Sunday, May 31, 2009. 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