2022-11-18 Colonial Williamsburg Campout

Informed Consent, Release Agreement, and Authorization


Activity: Colonial Williamsburg Campout
Date: November 18-20, 2022


Troop 51 will be going on a trip to Colonial Williamsburg. We will depart on Friday, November 18 at 5:00 PM from the upper parking lot of Floris United Methodist Church. Please assemble at 4:30. We will return Sunday, November 20 to FUMC around 1:00 PM unless drivers return Scouts directly to their homes. Activities on the trip will include: camping at Chippokes State Park and visiting the Jamestown settlement, Yorktown Battlefield, and Colonial Williamsburg. Pets are not allowed. Siblings younger than 11 years old are allowed.
Transportation will be by private vehicles and coordinated among participating families. Due to the logistics involved drivers are encouraged to spend the weekend.


All participants (Scouts and adults) should bring the 10 essentials, a daypack, a water bottle, and comfortable shoes. A current (within the last 12 months) BSA health & medical record (Part B) must be on file for all participants. All adults attending must have completed BSA Youth Protection Training (YPT).


The Troop Mulch funds will cover the camping fee and group tickets to Jamestown Settlement, and Yorktown Battlefield attractions. Registration is due November 8.


Emergency Contact Numbers during trip: Mr. Mark Christoffersen, Cell: 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.

Section 6 - Payment

$ 0.00