2023-08-11 Backpacking

Informed Consent, Release Agreement, and Authorization


Activity: Fall Backpacking
Date: August 11-13, 2023


Troop 51 will be going on a Backpacking trip. The location will be selected when we have determined the numbers and skill levels of attendees so that we can ensure all that want to go will be accommodated. Our goal is to select a location that is both nearby (1.5 hours or less) and able to challenge those who are experienced and offer a learning opportunity for those who may be new. The initial plan is to depart on Friday, August 11 in the morning and return on Sunday, August 13.


Transportation will by private car and drivers may be needed depending on attendance. Additional adult participants are also needed.


All participants (Scouts and adults) will need to bring everything needed in a backpack. The Troop will provide instruction on what this means leading up to the event. 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).


There is a $20 fee for this trip to cover backpacking dinners. All other meals, snacks and food is to be provided by individual participants. Please register ASAP so that routes, itinerary, and other plans can be made. Contact Mr. Jackson if you have any questions.


Emergency Contact Numbers during trip: Todd Jackson [571]-[213]-[2433]

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

Scout Account Requests can be completed post registration.
$ 0.00