Depart: Saturday, August 18, 2007 6:15 a.m. Return: Saturday, August 19, 2007 1:00 p.m.

1. signature of parent or gaurdian Emergency Contact: Name of parent being called: Phone #’s or Fort Frederick Trip Depart: Saturday, August 18, 2007 6:15 a.m. Return: Saturday, August 19, 2007 1:00 p.m. Bring a day pack, a prepared lunch, and one full water bottle all for use in a canoe Trip Cost $50.00 PLEASE have breakfast before we depart. Emergency Contact Mr. Dan 443 6046940 Please detach top of form and retain for your records Last Name First Name In consideration of the benefits to be derived and in view of the fact that the Boy Scouts of America is an educational institution, membership in which is voluntary, and having full confidence that every precaution will be taken to ensure the safety and well being of my Scout son(s)/ward(s) whose name(s) appear above; I agree to his participation in the above named activity and waive all claims against the leaders of this trip, officers, agents and representatives of the Boy Scouts of America, and the organizational sponsor. In the event of an emergency, the Troop leader of the above named activity has my permission to obtain medical treatment for this Scout at the nearest hospital or doctor, at my expense, if your own doctor is not readily available, and as restricted on the Emergency Data Sheet submitted with your application to Troop 432. This Scout is highly allergic or sensitive to: __________________________________ What, if any medication is he taking? _________________________________ Why is he taking this medication? _________________________________ Instructions for this medicine? ______________________________ Medical Insurance Provider:_____________________________ Phone Number for Insurer __________________________________Policy Number _______________________________ Parent providing coverage ss# _______________________________ If necessary provide more information on the back of this sheet.