Activity Authorization Form for Wheaton Troop 374 Campout to the vicinity of

Herrick Lake Forest Preserve, Wheaton, Illinois

I, the parent or legal guardian of ___________________________________, acknowledge that he will be traveling by bus, automobile, SUV and/or passenger van to Herrick Lake Forest Preserve in Wheaton, IL for a Wheaton Troop 374 campout on Saturday 01/10/2009. He will return on Sunday 01/11/2009. In order to participate, all scouts need to be properly prepared for a wide variety of weather condition possibilities. We will be tent camping in cold weather so all scouts need to be prepared for weather conditions such as cold, wet weather including snow and/or ice.

I hereby give my full consent and permission for this trip and to engage in all prescribed Boy Scouts activities for Troop 374’s Camping Trip/Scout Outing. I understand that the activities may be rigorous and that they may involve risk of serious injury. My son is in good physical condition and is fully able to participate in all prescribed activities. I have carefully considered the risks involved and agree to hold the Boy Scouts of America, Inc, Three Fires Council, BSA, BSA volunteers, and their respective officers, leader, agents representatives and employees harmless from all personal injury and illness arising out of, or resulting from, participation in such activities, including travel to and from such activities. The health history of my son, set forth in the Boy Scout Personal Health History (Class 1 & 2), is accurate unless any modifications are indicated at the base of this page. I also grant permission for photos of my son to be published on WheatonTroop374.org, as well as on the local and national Boy Scouts Council websites. In the event of illness or accident in the course of such activities, I request that measures be instituted without delay as the judgment of Scout leaders, volunteers and medical personnel dictate.

___________________________________________________________________

Date Signature of Parent and/or Legal Guardian

Your Phone numbers:_____________________________________________________

Alternate person #1: (and relationship) ______________________________________________________________________

Phone numbers: ____________________________________________________

Alternate person #2: (and relationship) ______________________________________________________________________

Phone numbers: ________________________________________________________

Cost: $15.00/person