Scout Personal Data
Please complete the information form for your child and family.
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Scout First Name *
Scout Last Name *
Street Address *
City *
Primary Family Phone Number *
Primary Phone Type *
Scout Email ( if scout doesn't have an email - indicate DNU) *
Scout Date of Birth *
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DD
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Scout Grade in School *
School Attending *
Was your child in Cub Scouts ? *
If yes, what years ?
What was the Scout's highest badge earned in Cub scouts?
Was your child in Boy scouts? *
What troop and council were you in?
Does your child have any Medical concerns? *
Does your child have any allergies? *
Who is your Medical Insurance with? (Company) *
What is the Policy ID and Group? *
Parent 1 First Name *
Parent 1 Last Name *
Parent 1 Relationship *
Parent 1 Email *
Parent 1 Phone *
Parent 2 First Name *
Parent 2 Last Name *
Parent 2 Relationship *
Parent 2 Email *
Parent 2 Phone *
Emergency Contact (name)- other than parents *
Emergency Contact (phone) other than parents *
Troop 78 Acknowledgement of Policies and Expectations - I understand that the operations, expectations, policies and procedures of Troop 78 are explained in the Troop 78 Guide.  I will familiarize myself with the troop by reviewing the guide and ensuring my child and other family members will participate in troop activities in a manner consistent with the guide. 

I AGREE

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Required
Signature of Participant *
Signature of Parent *
WAIVER AND RELEASE OF ALL CLAIMS

PLEASE READ THIS FORM CAREFULLY AS YOU WILL BE WAIVING YOUR RIGHTS AND/OR THE RIGHTS OF YOUR CHILD TO ALL CLAIMS FOR INJURIES YOU OR YOUR CIDLD MIGHT SUSTAIN ARISING OUT OF TROOP 78 PROGRAMS OR ACTIVITIES AND YOU WILL BE REQUIRED TO INDEMNIFY, HOLD  ARMLESS  AND  DEFEND  TROOP  78  FOR  ANY  CLAIMS ARISING OUT OF PARTICIPATION IN SAID PROGRAM.

I acknowledge that there are certain risks of injury, damage or loss associated with participating in Troop 78 programs and activities (''Programs'} I further understand that the Troop 78 is not required to carry medical insurance for injuries sustained from attendance at its Programs. I agree to assume the full risk of any injury, loss or damages regardless of severity, which I, or my child may sustain as a result of participating in Troop 78 Programs.

I agree to waive and relinquish all claims, demands, damages, rights of action; or causes of action, present or future, whether the same be known or unknown, anticipated or unanticipated, I may have or my child may have, associated with attending the Programs.

I do hereby agree to fully release, discharge, indemnify and hold harmless Troop 78 and the Community Christian Church, and their officers, agents, servants, employees and volunteers from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated or unanticipated, I may have or my child may have resulting from, associated with and/or arising out of attending and/or participating in the Programs, including but not limited to my or my child using Troop 78 facilities and equipment.

PERMISSION TO SECURE TREATMENT

In the event of emergency, I authorize Troop 78 adult leaders to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my immediate care or that of my child and I agree that I will be responsible for payment of any and all medical services required.

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I have read and fully understand the Waiver and Release of All Claims and Permission to Secure Treatment. I understand that the Wavier and Release of All Claims and Permission to Secure Treatment will be effective until revoked in writing by me and received by the Scoutmaster of Troop 78. WAIVER MUST BE SIGNED BY ALL PARTICIPANT(S) OR THEIR LEGAL GUARDIAN IF THEY ARE A MINOR

Signature of Participant *
Signature of Parent *
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