PARTICIPATION FORM

PARTICIPATION/PARENT PERMISSION FOR TRIPS/ACTIVITIES WITH

VENTURE CREW/TROOP 4, CANTON, OHIO

(Parental permission required for Venturers, Scouts or guests, less than 18 years of age, participating in a Venturing crew trip or activity.) 

has my permission to participate in 

(Venturer, Scout or guest)

(Activity or trip) (Date)

.

I know of no health or fitness restriction(s) that preclude participation. In the event of illness or injury occurring to my child while involved in this activity, I consent to X-ray examination, anesthesia, medical, or surgical diagnostic procedures or treatment that is considered necessary in the best judgment of the attending physician and performed by or under the supervision of a member of the medical staff of the hospital furnishing medicals services. (It is understood that in the event of a serious illness or injury, reasonable efforts to reach me will be attempted.)

Participant Date

Signature Date

Phone numbers where someone can be reached during the time of this activity:

Name Relationship:

Home ( )

Cell ( )

Work ( )