____________________________ (scout) has my permission to participate in all aspects of the above listed outing, as well as other related items that may arise on the agenda, with Troop 58 BSA. I realize there may be activities that can result in injuries. I give my permission to the representatives of Troop 58 to render any and all medical assistance they deem necessary. (This serves as permission to render medical treatment.)

Signed: _____________________________ Phone: __________________

Adult Participation: I will attend and drive __________________________

I will attend but will not drive ____________________________________

Driver's License number: ________________________________________

Vehicle Type and Year: _________________________________________

Vehicle Plate Number: _________________ Seatbelts: ________________