TROOP
671 PARENT / GUARDIAN PERMISSION SLIP
troop671.ocbsa.org on the
Internet
EVENT: Snow Sports Day at Bear
Mountain
March 2003
DATES:
from Saturday March 15, 2003 for one day only COST: See
Attached Form
TURNED IN BY:
2/24/03
LOCATION: Bear Mountain Ski Resort
Closest
Hospital:
43101 Goldmine Drive /
P.O. Box 6812 Bear Valley
Community
Big Bear Lake, CA 92315
41870
Garstin Rd.
General Information:
909-866-5766 Big Bear
Lake
Snow Report:
800-BEARMTN Phone:
(909) 866-6501
MEET AT: Saint Isadore ON: Sat.
3/15/03 AT:
5:30 AM
RETURN TO: Saint Isadore ON: Sat.
3/15/03 AT:
9:00 PM
SCOUTMASTER / ADULT
LEADER: Mr. Rick
Lovdahl
EMERGENCY
CONTACT:
Mrs. Anne Lovdahl Phone: 562-795-5000
_ PLEASE RETAIN TOP FOR YOUR RECORDS ____ .
MY SON _________________________________________ SSN: ______________________________
FROM:
Sat. 3/15/03 5:30 am TO: Sat 3/15/03 9:00 pm
LOCATION: Bear Mountain Ski Resort –
Big Bear Lake
I am ABLE / UNABLE to drive TO / FROM the event. My vehicle can transport ______ scouts/ scouters including myself. I certify that I have the required (BSA/BAC) amount of auto insurance, my vehicle is in good operating order and that all passengers will have seat belts. I also confirm that I have read and will obey the (BSA/BAC) auto safety requirements.
VEHICLE MAKE:_____________________________________ car / wagon / truck / van TAG No. _____________
I am ABLE / UNABLE to participate for the ENTIRE EVENT / FOLLOWING DAYS: ____________________
In case of an emergency, I understand that
every effort will be made to contact me. In the event that I cannot be reached,
I hereby give my permission to the physician selected by the adult leader in
charge to secure the proper treatment which may include emergency treatment,
hospitalization, anesthesia, surgery or injections of mediation to my son.
SIGNATURE:
_______________________________________________________
Date:
/ /
EMERGENCY CONTACT ____________________________ Tel#
________________ Relationship ______________
MEDICAL / HOSPITALIZATION INSURANCE INFORMATION
List of Medicines and attached directions for
use:
List of Medicines my son is allergic to:
List of items my son is allergic to (bee stings, cats, dogs, hayfever, any foods, rashes)
Name of Insurance Company:
___________________________________________________________________
Policy Number: _______________________________________ Group No:
_____________________________
Name of Insured: _________________________________________ SSN:
________________________________
Insured Employer Info: ___________________________________ Tel. No:
_______________________________
____________________________________________________________________________________________
____________________________________________________________________________________________