2023-09-22 Camp Highroad

Informed Consent, Release Agreement, and Authorization


Activity: Camp Highroad and Fall Court of Honor
Date: September 22-24, 2023


The Troop’s annual tradition of Camp Highroad and Fall Court of Honor will be Friday, September 22 – Sunday, September 24. Activities will include the high ropes course and zip line, archery, mountain boarding, and German spotlight tag.


All families are cordially invited to attend the Court of Honor on Saturday, 6:30 PM in the dining hall. Families are invited to the potluck dinner (to be coordinated by an adult volunteer) starting at 5:30 PM prior to the Court of Honor. Drinks and desserts will be provided. There is no need to register here for only attending the Court of Honor, but look for further emails regarding the potluck dinner.


Transportation will by private car and drivers may be needed depending on attendance. Campers and drivers should plan to meet at FUMC upper parking lot at 5:00 PM on Friday. Camp Highroad is located at 21164 Steptoe Hill Rd, Middleburg, VA 20117. We will camp at Locust Grove campsite. Campers will return Sunday morning with departure planned at 8:00 AM. The Troop is covering 50% of camping fees (a $13 value); activities are optional and have an associated fee for each participant. Additional adult participants are also needed.


To participate in activities and camp, please register and pay no later than Wednesday, September 13 in order for the Troop to provide participation counts and ensure adequate camp staffing.



A current (within the last 12 months) BSA health & medical record (Parts A & B) is required for all participants. Bring form(s) with you to check-in and it will be returned at the end of the campout. All adults attending must have completed BSA Youth Protection Training (YPT) in the past two years.


Emergency Contact Numbers during trip: Ron Johnson, 703-300-3611

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