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Print this page and mail to Cheri Vossberb, Plainview, Nebraska
Parents are encouraged to participate.  .


              Crew 270

Activity -                                                                                 Level Physical Exertion:
Place of Activity: -                                                                  Water activity: frozen only
Date of Activity:                                                                                                                                                                                  To Directory


I, ________________ do herein register for the above activity.   I do have the health and physical fitness
necessary for participation in this activity.

My level of swimming is: (check as applies)
___  nonswimmer // ___ beginner swimmer // ___ advanced swimmer // ___ Lifeguard
                                        (Lifeguard certified by ____)
Yes     No     I may drive and carry other Explorers.  I understand that to be eligible to drive:  1) I must
have had my full drivers license for at least six months, and 2) must not have had any accidents or
moving violations and 3) have my parents' permission and 4) during highway travel, caravan with an adult
Signed: ________________________________________ Date ________


We, the parents/guardians of the above Explorer to hereby give him/her our permission to participate in
the above activity.
          In consideration of the benefits to be derived from participation in the activity, any and all claims against the Boy Scouts of America, or its local
     councils, Explorer post, and chartered organizations, or against the officers, employees, agents, or other representatives of any of them, or any
     other persons working under their direction or engaged in the conduct of their affairs, arising out of any accident, illness, injury, damage, or other
     loss or harm to/or incurred or suffered by the applicant named above or to his or her property, in connection with or incidental to the post trip or
     activity, including preliminary training and travel, are hereby expressly waived by the applicant and the applicant's family or guardians.


Yes     No     The above Explorer has our permission to drive himself and other Explorers /Leaders for
this activity.
We can and will help in the following means:
_____     Transport Explorers to the activity.  We can transport #____ Explorers.

_____     Transport Explorers home from the activity.  We can transport #_____ Explorers.

_____     Participate in the full Activity. (We need at least one adult of each gender of Explorer

_____     Participate in any portion (define) of the Activity.

_____     Prepare food or snacks ahead of time for use on the Activity.

_____     Loan gear (describe) for use by the Explorers for the Activity.

                                                                 Signed: ________________________________________ Date ________

mail to GT Surber, 1202 Norfolk Avenue, Norfolk, Nebraska 68701
Crew  270

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