BOY SCOUTS OF AMERICA - TROOP 893
CENTREVILLE UNITED METHODIST CHURCH

EVENT:
MEET AT:                                                  DATE:                      TIME:
RETURN TO:                                             DATE:                      TIME:
DRESS:
INDIVIDUAL EQUIPMENT: (X = required ? = optional)

  BACKPACK   SLEEPING BAG   FLASHLIGHT
  DAY PACK   SLEEPING MAT   MATCHES/LIGHTER
  CANTEEN/ WATER BOTTLE    EXTRA CLOTHING   SURVIVAL KIT
  FIRST AID KIT   EXTRA SOCKS   SCOUT STAVE
  COMPASS   EXTRA SHOES    
  PAPER/PEN/PENCIL   GLOVES    
  SCOUT HANDBOOK   COLD WEATHER HAT    
  RAIN GEAR/PONCHO   PERSONAL MESS KIT     
  BAG LUNCH/TRAIL FOOD   PERSONAL UTENSILS     

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PERMISSION TO PARTICIPATE AND RELEASE OF LIABILITY

SCOUTS: Please ask your parents to read and sign this form below. Bring the signed form with you to the event. You must have a signed permission form to participate.

SCOUT __________________________________________ has permission to participate in the
                                   (name)

___________________________________________from ________ to _______, 19__.
                                  (activity)                                                        (month/day)   (month/day)  (year)

In consideration for the benefits derived, we expressly waive all claims against the troop, local and national councils of the Boy Scouts of America, or their representatives in the event of any accident, injury, illness or other damage that may occur in connection with, or incident to this event. The Scout's physical condition HAS NOT/HAS (mark one) changed since the last physical examination. I understand that adult leaders more than 21 years of age will supervise all activities.

IN CASE OF EMERGENCY, NOTIFY ________________________________________
                                                                                                     (name)                                                             AT_________________________________________
                                                                                          (phone number/s)

SPECIAL MEDICAL INFORMATION LEADERS SHOULD KNOW (if applicable):

PARENT/GUARDIAN_______________________________________DATE__________PHONE___________
                                                               (signature)