Re: Premission Slip Text

Ron,

I tried to copy our troop's form for emergency treatment here but all the
lines and boxes vanished. We have the Scout's parents complete this once a
year. We store the forms in a notebook which we take on each trip; when our
high adventure group leaves base camp next week, their forms will be pulled
and carried by the trek leader. (He won't want to come back to camp to get
the form if he needs it.) The only other difference from the ones already
posted is that ours is notarized. By the way, we've never had to use one
(knock on wood).
------------------------------------------------------

AUTHORIZATION TROOP 18 BSA
FOR EMERGENCY CAZENOVIA
MEDICAL TREATMENT NY 13035

NAME OF SCOUT BIRTHDATE SOCIAL SECURITY NUMBER

IDENTIFY ALLERGIES OR SPECIAL CONDITIONS

I, being the parent or legal guardian of the above named minor, do hereby
appoint:

NAMEADDRESSPHONE
George Schmit 3234 Moraine Rd, Cazenovia, NY 13035 655-2500
(we list the scoutmaster and his six assistants in this area)

To act in my behalf in authorizing unexpected medical, dental, surgical care
and hospitalization for the above named minor during the period of my
absence,
from July 1, 1994through June 30, 1995
This document shall be presented to a physician, dentist, or appropriate
hospital representative at such time as unexpected medical, dental, surgical
care, or hospitalization may be required.

PARENT / GUARDIAN (PRINTED FIRST, THEN SIGNATURE)

STREET or PO BOXDATE

CITY, STATE ZIP PHONE NUMBER
( )

HOSPITALIZATION COVERAGE FOR ABOVE NAMED MINOR:
INSURANCE COMPANY OR GOVERNMENT PROGRAMI.D. OR CONTRACT NUMBER

FAMILY PHYSICIAN PHONE NUMBER
( )

List any medications the Scout is taking:

List special instructions for these medications:

Do you want the adult leader to carry the medications? YES NO

List date of last tetanus shot / booster:

STATE OF NEW YORK
COUNTY OF MADISON
On this day of
, 19 ,
before me personally appeared

to me known and known to me to be the same person described in and who
executed the
foregoing instrument, and he duly acknowledged to me that he executed
the same.

------------------------------------------------------
YiS, George GSchmit@AOL.COM
ASM, Trp 18 Cazenovia, NY 13035-9418

"It is the customary fate of new truths to begin as heresies and to
end as superstitions." TH Huxley: The Coming of Age of "The Origin of
Species" (1880)

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