2023-03-24 Shooting Sports Campout

Informed Consent, Release Agreement, and Authorization


Activity: 2023 Annual Shooting Sports Campout, Troop 51 and Troop 7
Date: 24 - 26 March 2023


Troop 51 and Troop 7 will be camping at BSA Camp Rock Enon (CRE) Scout Reservation located at 292 Rock Enon Springs Rd, Gore, VA 22637. CRE is located in the northwestern tip of Virginia, an easy 20 minute drive west of Winchester, VA and just minutes away from West Virginia, with easy access just 5 miles off of US Route 50. Attendance at safety briefs will be required in order to participate in activities.


We will depart on 24 March no later than 530pm from the upper parking lot at Floris United Methodist Church. We plan to arrive at CRE no later than 7:00 pm. We expect to conclude with activities by noon on Sunday, 26 March.


Activities on the trip will include Rifle and Shotgun shooting as well as archery, tent camping, the potential for short hikes and outdoor cooking. The focus of the program will be on the proper care and use of .22 caliber rifles, 12 gauge shotguns, black powder rifles and archery equipment.


All participants (scouts and adults) should bring the 10 essentials, daypacks, a tent, mess kit, masks, hand sanitizer, and dress appropriately for the weather (always plan for rain). Use of Scout’s electronic devices during the event for a Scouting purpose MUST be approved by the Scoutmaster. Cell coverage is weak or spotty. A current (within the last 12 months) BSA health exam and medical record (Parts A and B only) must be on file for all participants. All adults attending must have completed BSA Youth Protection Training (YPT).


Please register by 1 March 2023. Refunds will be considered based on registration numbers if cancellation is made no later than 15 March 2023.


Fees include $55 for campsite, range, gun rental fees and ammunition, plus the standard $25 grub fee for a total of $80. Scout registrations will be reduced by $15 due to the mulch fundraiser subsidy. A full commitment is to complete the on-line information with payment.


Emergency Contact Numbers during trip: Mark Christoffersen: [571-685-3395], Peter Young: [703-851-0161]

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