2023-5-19 Harpers Ferry and New Scout Campout

Informed Consent, Release Agreement, and Authorization


Activity: Harpers Ferry and New Scout Campout
Date: May 19-21, 2023


Troop 51 will camp near Harpers Ferry at the UMC Manidokan Camp & Retreat Center at 1600 Harpers Ferry Rd, Knoxville, MD 21758. This is our annual New Scout campout, but there will be activities for everyone. We will assemble at FUMC's upper parking lot at 5:00 PM on Friday, May 19 to coordinate drivers and load gear. We will depart as soon as we are ready; the goal is no later than 5:30 PM. We will return Sunday, May 21 to Floris Elementary School at approximately 10:00 AM unless drivers return Scouts directly to their homes. 


Activities on the trip will include hiking, Scout skills, a campfire program, and potentially a visit to Antietam Battlefield. Our tradition for the new Scout campout is that adults will do the cooking (hint, need volunteers). New Scouts will work on first aid, woods tools, campfire building, knot tying, nature, and other Scout skills for rank advancement.  Siblings are allowed and require an accompanying adult.  Pets are allowed.  This is a plop-camping event.  All participants (Scouts and adults) should bring the 10 essentials, day-packs, mess kit, and dress appropriately for the weather (always plan for rain).  There is a potable water supply.  Use of Scout’s electronic devices during the event for a Scouting purpose MUST be approved by a Scoutmaster. Cell coverage is weak or spotty. 


All participants must also bring a current (within the last 12 months) BSA health & medical record (Part B) to turn in during assembly. All adults attending must have completed BSA Youth Protection Training (YPT).  


This cost is $35 for Scouts and $40 for adults and siblings (11+ years old). The cost covers camp fees and food; this includes the Troop covering a portion of the camp fees. COMMITMENT is due May 10 to allow for proper planning.  


Emergency Contact Numbers during trip:  Mr. 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