Pack 198 Activities
Parental Permission/Release Form
PLEASE COMPLETE ALL TWO PARTS
1. My son/ward _________________________, has my permission to participate in the Pack 198 activity: ________________________________ from _______, ___________, _________________________. In the case of injury or illness, the leaders of Pack 198 are authorized to render emergency first aid and/or seek all necessary medical attention. In such cases, I understand that I will be notified as soon as possible. I agree to hold harmless and blameless, the leadership of Pack 198 (including members of Pack 198's committee and any additional adults participating in or providing assistance to the activity) and West TV Elementary or Cedar Park Middle School from any injury or illness resulting from participation in this activity. I waive all rights to any civil action against the above mentioned parties. I have noted any medical or other special consideration on the BSA Personal Health & Medical Record, Class1 Form; if my son has had any serious illness, injury, or medical treatment over approximately the last 6 weeks of which the Pack should be aware, I have provided the details on the upper half of the back of this permission slip (check here if applicable: _____). I understand that a medical clearance or doctor’s note may be required prior to participation.
(Printed Name of Parent or Guardian) (Signature of Parent or Guardian) (Date)
2. If you will not be home or work during this event, please list an emergency telephone number where you can be reached (and, if not you, the contact person at that number)