GREATER YOSEMITE AREA COUNCIL BOY SCOUTS OF AMERICARuss AsaiRuss Asai202007-12-11T07:01:00Z2007-12-11T07:01:00Z15022864236336011.0000GREATER YOSEMITE AREA COUNCIL BOY SCOUTS OF AMERICATROOP 21PARENT/GUARDIAN PERMISSION TO PARTICIPATE IN TROOP ACTIVITIESwww.bsatroop21.netJanuary 1, _____ Thru December 31, _____ Current year Following yearPursuant to California Civil Code Section 25.8Pursuant to California Penal Code Section 12552 I, ________________________ the PARENT/GUARDIAN of ________________________ give my permission for him to attend ALL TROOP AND PATROL activities within the above year. At the time of this signing, he is in good physical condition. If, at the time of activity, he is not feeling well or I am aware that he has been exposed to a communicable disease, then I will make sure that he does not attend. FOR MEDICAL CONDITIONS, SEE ATTACHED FORM: If, in the opinion of the adult in charge of the event, it becomes necessary, the leaders may give FIRST AID to my/our son or take him to qualified medical personnel for emergency treatment, yes / no. (If “no” write reason and signed statement giving release from liability and any alternate instructions on the reverse side.) The undersigned does hereby authorize the Scoutmaster of Troop 21, Greater Yosemite Area Council, Boy Scouts of America or such substitute as he/she may designate, as agent for the undersigned, to consent to any X-rays, examination, anesthetic, medical, dental or surgical treatment and/or hospital care for the above minor which may be deemed advisable by, and rendered under the general or special supervision of, any qualified medical personnel licensed under the provision of medicine practice act, whether such treatment is rendered at the office or said qualified medical personnel, at a hospital, Scout camp or elsewhere. This authorization will be in effect while the above minor is in route to or from, or involved or participating in, any troop activity or any activity of the Greater Yosemite Area Council, Boy Scouts of America, unless revoked in writing by the undersigned and delivered to the Scoutmaster of Troop 21. In case of emergency, I can be reached at: Name of Son’s Patrol: ____________________________ Scout’s Birthday:__________________ Parent / Guardian #1 Name: _____________________________ Home Phone #___________________Work phone: ________________ Cell #: _______________ E-mail address: _____________________ Home address: _____________________________________________________________________Parent / Guardian #2 Name: ___________________________ Home Phone #_____________________ Work phone: ________________ Cell #: _______________ E-mail address: _____________________ Home address: _____________________________________________________________________Insurance Carrier: _____________________________________________________________ Policy #:____________________ Primary insured: __________________________ Make/Model of vehicle: _______________________________ Year ___________________ Drivers License#___________________ # passenger w/seat belts _____  Parent Name (Print): _____________________________Signature: _____________________________  If I cannot be contacted, please call: Name:___________________________Phone#: ___________________ Address: ___________________________Cell #:___________________