Mount Baker Council 2009 University of Scouting

Youth Permission Slip

To be used by Scouts and Venturers 14 –17 years old
attending the University of Scouting

has my permission to participate in
(Scout or Venturer)

Activity:       University of Scouting
Date:           January 24, 2009
Where:        Haller Middle School
Cost:           See registration form

Adult attending the University of Scouting with youth:

I know of no health or fitness restrictions that preclude participation. In the event of illness or injury occurring to my son or daughter 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 medical services. (It is understood that in the event of a serious illness or injury, reasonable efforts to reach me will be attempted)

Scout Leader Signature:
Date:



Parent/Guardian Signature:
Date:

Name (Printed):
Phone number where I can be reached:

Emergency contact:
Phone: