2023-06-18 Summer Camp – Camp Freedom

Informed Consent, Release Agreement, and Authorization


Activity: 2023 Summer Camp at BSA Camp Freedom
Date: 18 - 23 June 2023


Troop 51 will attend resident camp at BSA Camp Freedom located at Heritage Scout Reservation near Farmington, PA. The camp was selected for its strong merit badge program for all Scouts, the Day Trek activities for 14 and older, as well as the modern facilities and reasonable price when weighed against other locations. The June date and the mountain site makes for a pleasant temperature during the week. FYI, the end of the regular school year in Fairfax County is on Friday, 16 June, which played into our date selection as we hope for a good attendance before families get busy with their summer events.



We will depart on 18 June no later than 8:00 am from the upper parking lot at Floris United Methodist Church. We plan to arrive at Camp no later than 11:00 am. Activities includes over 50 merit badge offerings, a first-year camper program, the Day Trek older Scout adventure program, and more. Day Treks are for Scouts 14 years and older and can be blended with merit badge work, if desired. Day Trek activities include:


-Whitewater Rafting


-Rifle and Shotgun Shooting at 7 Springs

-Cowboy Pistol Range


Note that last year each Day Trek had a supplemental $50 fee. Once we learn the price for 2023, we will send that along to the Troop.


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, B, and C) must be on file for all participants. All adults attending must have completed BSA Youth Protection Training (YPT).


In order to qualify for the early bird price savings, registration and payment must be submitted by March. Besides registration each Scout will need to complete:


-2023 Medical Form

-The Summer Camp Parent Permission Release Form

-Swim test before departing for camp

-Day Trek Activities release Form (if taking any of the release forms)

-Draft of merit badges sent to coordinator (due date TBD)

-Day Trek Scouts will need to bring two copies of the medical forms.


Finally, we are looking for another adult or two to attend camp. Troop 51 will cover any fees associated with adult participation. Parents, you are welcome to attend anytime during the week. Additional information will be shared in the months ahead detailing due dates, points-of-contact, fees, form collection dates, and all of the administrative work and requirements needed for a successful summer camp.


Emergency Contact 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.