TROOP 17, BOY SCOUTS OF AMERICA

Fairview Fire Department

Rt. 9G, Poughkeepsie, NY 12601 

Scoutmaster and/or Designated Adult Leader(s):

            In consideration of the benefits to be derived and in view of the fact that the Boy Scouts of America is an educational institution, membership in which is voluntary, and having full confidence, that every precaution will be taken to ensure the safety and well being of my son(s), namely:

____________________________________________
____________________________________________
 ____________________________________________  

on all Troop 17 events.

            I agree to his participation and waive all claims against the Troop Unit Leaders for the event, officers, agents, sponsor or the Boy Scouts of America.

            In the  event of an emergency, the designated troop leader(s) for the event has my permission to obtain medical treatment, at my expense, for this scout at the nearest hospital or doctor.  All medical information is listed on the Class 1 Personal Health and Medical Record (#34414), which is updated annually.

  

                                                                  

______________________________________________ 

 Signature of Parent or Guardian                        Date