2021-7-18 Camp Henson

Informed Consent, Release Agreement, and Authorization

Activity: Summer Camp at Henson Scout Reservation (HSR), Galestown, MD
Date: July 18-24, 2021

Troop 51 will be going to summer camp at Camp Henson

Transportation will be on your own (or as arranged between families) and driving by private car.Due to COVID-19 restrictions and mitigations, families are responsible for their Scout’s arrival at HSR in coordination with the lead Scoutmaster.  HSR request’s that all transport be conducted via the families privately owned vehicle.  A second Scout can ride in a non-family vehicle, according to the HSR COVID mitigation guidance. 

All participants (Scouts and adults) should bring the 10 essentials and dress appropriate to the weather (plan for rain). Use of Scout’s electronic devices during the event for a Scouting purpose MUST be approved by the Scoutmaster. All adults attending must have completed BSA Youth Protection Training (YPT).

A copy of your Scout’s BSA health & medical records, parts A, B and C should be turned into the Troop 51 Summer Camp coordinator, Bhawna Seghal prior to departure.  These copies will not be returned at the end of camp. The HSR local council will destroy these forms at an appropriate date following camp. 

Emergency Contact Numbers during trip: Mark Christoffersen: [571] [685]-[3395]

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.