Print and fill out this form:

As the parent or legal guardian of _______________________________________,
I hereby give my permission for him to attend PACK 16 FAMILY CAMP-OUT on the following dates, May 30th to June 1 2008,  to be held at  Bill Baggs State Park .

In case of an emergency please contact me at the following telephone numbers:

__________________________ or _______________________.

If unable to reach me please contact one of the following individuals:

Name Phone # and  Relation to boy

________________________________________________________________


________________________________________________________________


I give permission to the leaders of Pack 16 to render First Aid, should the need arise. In the event of an mergency, understand every effort will be made to contact me (my spouse or next of kin). In the event I cannot be reached, I hereby give my permission to the physician selected by the adult leader in charge to secure proper treatment for my child. I further agree to waive all claims against Boy Scouts of America, South Florida Council, Tequesta District, St. Theresa Home School Association, Pack 16 and its leaders/agents and representatives, and hold them (the above mentioned) blameless of personal injury, liability, claims, and expenses that might occur during this activity/outing.




Date: ________ Signature of Parent/Guardian: __________________________