BOY SCOUT TROOP 88

San Francisco, CA

Scout's Name ____________________ __

Activity ___January 22-23, 2005 – Pt Reyes Backpacking Trip_______________

GENERAL PERMISSION AND POWER OF ATTORNEY

This form must be completed and given to the adult leader for each activity.

I understand that Troop 88, BSA, will provide adequate supervision for this activity and that every reasonable effort will be taken to ensure the safety of the participants. I agree that the Boy Scouts of America and Troop 88 cannot assume responsibility for accidents or loss of personal property. I therefore release Troop 88 from any claim that may arise out of this activity and specifically agree not to sue or bring any action against Troop 88.

In case of emergency, I understand every reasonable effort will be made to contact me. In the event I cannot be reached, I hereby agree and give my permission to the physician selected by the adult leader in charge to secure proper emergency treatment which may include hospitalization, anesthesia, surgery or injections of medication for my son until I release the adult leader from responsibility.

I have read the above, understand it and agree to its content.

Date: _____________2005 Parent or Guardian

Print Name

Address:

Telephone:

Doctor's Name: Phone:

Health Plan Name: Group No.:

Identification No.: