Troop 1776 Activity Information & Permission Form

Replies due 15 February 2009

Planned Activities: Wilderness Survival Camping
Location: High Falls State Park
Date & Time: February 18 - 20, 2011
Meet at LaSalette Hall at 5:30 PM, QMs assemble by 5:00
Return: February 20 about 12:30 PM
Cost: $25 per Camper for Camping and parking Fee
This includes your Patrol Food Costs
Equipment Personal Gear, Share Tents, Etc.
Required: Wilderness Survival gear to spend the night in a self made shelter.
Patrols to cook Saturday meals. Gray Hares to cook Sunday breakfast
Adult Contact: Scott Harris – 404-319-9021
Emergency Contact: Micheline Harris – 404-723-5014
Keep the top portion as a reminder and return the bottom to Scott Harris.
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Wilderness Survival, 18-20 February 2011

Scout Name:___________________________________________________________________

Yes No Does your Scout have permission to attend the Troop 1776 Event?
If “Yes”, complete the following questions. If “No”, describe the reasons on the back.

Yes No Is your Scout taking any medications at this time?

___________________________________________________________

Yes No Does your Scout have a medical condition the leaders should know about?
____________________________________________________________

Yes No Should your Scout be restricted from any of the planned activities?
____________________________________________________________
Yes No Are you available to assist with this Troop activity?
Yes No Can you drive Scouts to or from this Troop activity? How many Seatbelts?______
Yes No Is your liability insurance information on file with the Troop Secretary?

I have reviewed the activities planned for this Troop outgoing and fully accept the risks
associated with my son’s participation.

_______________________________ _____________
Signature of Parent or Guardian Date