TROOP 416
INFORMED CONSENT AND HOLD HARMLESS AGREEMENT

 

 

I understand participation in activities offered through Troop 416,
the Arrowhead District, and the Circle Ten Council, Boy Scouts of America,
involves a certain degree of risk.
I have carefully considered the risk involved and have given my child

 

_____________________________________________________________,

 my consent to participate on the dates noted and initialed by me.

 

         Date                Initial

 

1.__________     __________            7.__________     __________

 

2.__________     __________            8.__________     __________

 

3.__________     __________            9.__________     __________

 

4.__________     __________          10._________     __________

 

5.__________     __________          11.__________     __________

 

6.__________     __________          12.__________     __________

 

 

 

Signature_____________________________________________________

Date_________________________________________________________

 

Telephone numbers for me (or others) in case of emergency.

 

1.____________________________________________________________

 

2.____________________________________________________________

 

3.____________________________________________________________

 

Revised July 15, 2006