2025-07-19 “Pohick Bay” Campout

Informed Consent, Release Agreement, and Authorization

 

Activity: Pohick Bay Campout
Date: July 19-20, 2025 (One Night)

 

Get ready for an unforgettable July campout at Pohick Bay Regional Park! Located just a short 45-minute drive from FUMC in Lorton, Virginia, this expansive 1,000-acre park provides the perfect backdrop for adventure and skill-building. Scouts will have the chance to hone their outdoor skills through camping and cooking, explore the park’s scenic trails on exciting hikes, and if they choose, experience the thrill of biking, fishing, and paddling.

 

The Troop will meet at Floris United Methodist Church (FUMC) in the upper parking lot on Saturday, July 19 at 9:00 AM ET and return on Sunday, July 20.

 

Transportation to the “Pohick Bay” camp site will be by private car (~45-minute drive). A volunteer driving coordinator is requested. Additional adult participants may also be needed.

 

There is $45 fee ($20 camping fee + $25 grub fee) per participant for this event.

 

Please register no later than Tuesday, July 08, 2025 to allow Scout Leaders and Patrols to adequately plan.

 

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

 

Emergency Contact Numbers during trip: Ketan Patel, 510-396-6086

Section 1 – Main Participant


Section 2 – Additional Participants

In addition to the main participant

Section 3 – Additional Contact Information

Include for anyone that you would like to receive emails about this event only. These email addresses will be used as the primary method of communications for this event.
Include for anyone that you would like to receive emails about this event only. These email addresses will be used as the primary method of communications for this event.
Include for anyone that you would like to receive emails about this event only. These email addresses will be used as the primary method of communications for this event.

Section 4 – Medical Information

Section 5 – Transportation

Include your own Scout(s). Allow room in your vehicle for some gear.
The transportation coordinator plans for transportation to and from campout, including ensuring drivers can carry all camp participants and camping gear, recruiting additional drivers if needed, and accounting for drivers that cannot be at the “meet-up” on Friday. Details will be provided by the lead ASM. Note: All participants are highly encouraged to be at meet-up to allow for Scout leadership of campout, ensure medical forms are collected, and ensure any gear needed from the trailer is properly checked out.

Section 6 – 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 7 – Payment

$0.00