2022-10-21 Sandy Point State Park (MD)

Informed Consent, Release Agreement, and Authorization

 

Activity: 2022-10-21 Sandy Point State Park
Dates: October 21-23

 

Troop 51 will be going on a trip to Sandy Point State Park in Annapolis, MD. We will depart on Friday, October 21 at 5:00 PM from the upper parking lot of Floris United Methodist Church. Please assemble at 4:30 PM. We will return Sunday, October 23 to Floris Elementary School around 10:00 AM unless drivers return Scouts to their homes. Activities on the trip will include: hiking, fishing, and fun on the beach of the Chesapeake. Pets are NOT allowed. Siblings younger than 11 years old are allowed, but must be accompanied by an adult and do NOT need to be registered.
Transportation will be by private car with coordinated carpooling.

 

All participants (Scouts and adults) should bring the 10 essentials, fishing equipment, beachwear, and beach toys. 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 Annual Health & Medical Record (Part B) must be on file for all participants. All adults attending must have completed BSA Youth Protection Training (YPT).

 

There is $25 grub fee. COMMITMENT is due October 12.  

 

Emergency Contact Numbers during trip are TBD, but will be distributed prior to the event.

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