Trip Plan

Trip Plan of _________________________________________________________________

Date and Time of Departure:___________________________________________________

Date and Time of Return:______________________________________________________

Destination:__________________________________________________________________

Adults Who Go Along:__________________________________________________________

______________________________________________________________________________

Route Going:__________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Route Returning:______________________________________________________________

______________________________________________________________________________

Permits Required:_____________________________________________________________

______________________________________________________________________________

Special Equipment Needs:______________________________________________________

______________________________________________________________________________

Special Clothing Needs:_______________________________________________________

______________________________________________________________________________


                           Permission Slip
                           ( Parents Copy )

Troop/Pack_______Patrol/Den_______is going to hike/camp on ___________________

19____ and will return on ____________________________________________________

Time leaving: ________________________ Time returning: _______________________

Cost: _______________________________________________________________________.

Place meeting or leaving from: _______________________________________________

Trip to: _____________________________________________________________________

If you need to contact your Scout and only in case of an emergency call ______

______________________________________________________________________________

phone ______________________________________________________ .     ( It may be

extremely difficult to make contact, especially if hiking. )

Please detach and retain this section and return the rest of this form and any
cost.  If you and your Scout wish to schedule a trip/event, fill out the top
half of this form at the most convenient time of meeting for the boys review.




                          Waiver of Responsibility
            ( Scout leader carries this part, one for each Scout )

Sponsor: ____________________________________________________________________

In consideration of the benefits to be derived, and in view of the fact that
the Boy Scouts of America is an educational institution, membership in which
is voluntary, and having full confidence that every precation will be taken
to ensure the safety and well being of my Scout son(s)/ward(s), namely:

___________________________________________________________________ on the
activity named below,  I agree to his participation and waive all claims
against the leaders of this trip, officers, agents, and representatives of
the Boy Scouts of America, and the sponsor.

In the event of an emergency, the troop/pack unit leader of the activity
named below has my permission to obtain medical treatment for this Scout
at the nearest hospital or doctor, at my expense, if our own doctor is not
readily available, and as restricted on the Emergency Data Sheet on file
with Troop/Pack _____________.
                              _____________________________________________
                              ( Signature of parent or guardian and date )

Activity: ___________________________________________________________________

EMERGENCY  INFORMATION  (In addition to personal Health and Medical Record.)

During the activity listed above, I can be contacted at the following phones
and will accept long distance calls.

(________) _____________________ ; (________) ____________________________

The Scout is highly allergic or sensitive to ________________________________

_____________________________________________________________________________
What, if any, medication is the Scout taking?

_____________________________________________________________________________
Any special instructions for this medication?

_____________________________________________________________________________
Do you want the leader to carry the medication?
                           YES____           NO____         (check one)
Use the back of this form for additional information and for explanation of
any other problems the activity leader should be aware of.

Date of latest or last tetanous shot/booster ________________________________
MEDICAL INSURANCE INFORMATION:
                    Company _________________________________________________

Policy No. ___________________________ (Control No. if group policy) ________

______________________________________ Other ________________________________.