Print this page and mail to Cheri Vossberb,
Plainview, Nebraska
.
Parents are encouraged to participate. .
REGISTRATION, PERMISION and ASSISTANCE FORM
Crew 270
Activity -
Level Physical Exertion:
Place of Activity: -
Water activity: frozen only
Date of Activity:
To Directory
Registration:
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
driver.
Signed: ________________________________________ Date ________
Permission:
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.
Assistance:
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
participating.)
_____ 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
REGISTRATION AND PERMISSION FORM
Crew 270
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