INFORMED CONSENT, RELEASE AGREEMENT, AND AUTHORIZATION
I understand that participation in Scouting activities involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered. Information about those activities may be obtained from the venue, activity coordinators, or local council. I also understand that participation in these activities is entirely voluntary and requires participants to follow instructions and abide by all applicable rules and the standards of conduct.
In case of an emergency involving my child, I understand that efforts will be made to contact me. In the event I cannot be reached, permission is hereby given to the medical provider to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose protected health information to the adult in charge and/or any physician or health care provider involved in providing medical care to the participant.
Protected Health Information/Confidential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.
With appreciation of the dangers and risks associated with programs and activities including preparations for and transportation to and from the activity, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against the Boy Scouts of America, the local council, Troop 306, Catonsville Presbyterian Church, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with any program or activity.
NOTE: The Boy Scouts of America and local councils cannot continually monitor compliance of program participants or any limitations imposed upon them by parents or medical providers. List any restrictions imposed on a child participant in connection with programs or activities and counsel your child to comply with those restrictions.
I give my permission for the above listed Scout(s) who is a registered member of Boy Scout Troop 306 to participate in the Musser Scout Reservation Cabin Camping/Leadership Training, February 16th thru the 18th. I agree that my son is in good health and may participate in strenuous physical activity. I give my permission for my son to receive medical treatment in the event of an emergency. I understand that Boy Scout activity insurance is secondary to my own insurance. I give permission for my son to be photographed for publicity purposes. I understand that my son will be traveling in a private vehicle, driven by a licensed driver. I agree that he will not attend this event if he is exposed to or becomes ill from a contagious disease. I understand that our first priority is for the Scouts to be safe and have a good time.
My typed name below serves as my signature as the parent of the above listed Scout(s) in agreement with the above release and authorization:
