2021-10-23 Gettysburg Campout – Registration

Informed Consent, Release Agreement, and Authorization

Activity: Gettysburg Scout Campout
Date: October 22-24, 2021

Troop 51 will be going on a trip to Gettysburg National Military Park. We will depart on Friday, October 22, 2021 by 5:00pm or earlier. The drive time is 1:30hrs. We will camp at the Historic Lady Daniel Farm on Hanover Street in Gettysburg (Address: 986 Hanover Rd, Gettysburg, PA 17325) and meet directly at the campsite. We will return Sunday, October 24, 2021 and plan to arrive home at approximately 10:30 a.m. The farm served as a staging area and field hospital for Confederate troops during the attack on Culp’s Hill. The Lady Daniel Lady Farm is also hosting a World War II weekend with WWII music and living history, including a canteen style dance Saturday night in their conference building.

Activities on the trip will include: hiking, historical tours, cooking, and camping. On Saturday, we will enjoy the Civil War history of the Lady Daniel Farm, the World War II activities for a portion of the day, and plan to walk approximately three miles touring Gettysburg National Military Park. The plan is to carpool to the Military Park from Lady Daniel Farm. Pets are NOT allowed.

Transportation will be on your own (or as arranged between families) and driving by private car. Carpooling is encouraged if participating families are comfortable, particularly to assist scouts whose families are not camping.

All participants (Scouts and adults) should bring the 10 essentials, a daypack, a mess kit, personal camping gear, and dress appropriate for the weather (plan for rain). Camping and food will be organized by Patrols. Scouts and adults are asked to have a mask, follow CDC guidelines, and comply with requests of our hosts. Use of Scout’s electronic devices during the event for a Scouting purpose MUST be approved by the Scoutmaster. A current (within the last 12 months) BSA health & medical record (Part B) MUST be turned in to the Senior Patrol Leader or an Adult lead on Friday or sooner. All medical forms will be returned to the Scouts at the conclusion of the campout. All adults attending must have completed BSA Youth Protection Training (YPT).

Emergency Contact Numbers during trip: Shaleen Kaul: [703] [282]-[2235]

Camping fee: $22 per person (adult or scout or sibling). Grub fee: $27 per person. Registration and payments are due by October 13th. Once you complete your registration below, the booking is non-refundable

Section 1 - Main Participant

Section 2 - Additional Participants

In addition to the main participant

Section 3 - Additional Contact Information

Section 4 - Medical Information

Section 5 - Consent

I understand that participation in Scouting activities involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered. Information about those activities may be obtained from the venue, activity coordinators, or local council. I also understand that participation in these activities is entirely voluntary and requires participants to follow instructions and abide by all applicable rules and the standards of conduct. I understand that COVID-19 is also a risk, particularly when gathering in groups; have received Troop guidance pertaining to gathering safely and agree to comply; and acknowledge that “Safe” is NOT the same as “Risk-Free.”


I have carefully considered the risk involved and hereby give my informed consent for my child to participate in all activities offered in the program. I further authorize the sharing of the information with any BSA volunteers or professionals who need to know of medical conditions that may require special consideration in conducting Scouting activities.


With appreciation of the dangers and risks associated with programs and activities including preparations for and transportation to and from the activity, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with any program or activity.


In case of an emergency involving my child, I understand that efforts will be made to contact me. In the event I cannot be reached, permission is hereby given to the medical provider to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose protected health information to the adult in charge and/or any physician or health care provider involved in providing medical care to the participant. Protected Health Information/Confidential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.


Troop 51 cannot continually monitor compliance of program participants or any limitations imposed upon them by parents or medical providers. However, so that leaders can be as familiar as possible with any limitations, list any restrictions imposed on a child participant in connection with programs or activities below and counsel your child to comply with those restrictions.

Section 6 - Payment

$ 0.00