VENTURE CREW 312 PERMISSION FORM
Youth’s Name___________________________________________________________
Address________________________________________________________________
City/State/ZIP_______________________Phone______________Cell_____________
Medical Insurance Co._______________________Policy No.____________________
Family Doctor______________________________Phone________________________
Youth religious affiliation: Catholic____Protestant___Jewish___Muslim___Other_
I hereby approve and agree to all of the terms and conditions of this application and
certify to its correctness. Further, I certify my child can meet the health and physical
fitness requirements of the Crew’s activities. I understand that this form grants
permission for any and all Crew activities my child may participate in once he or she
joins.
For any water-based activities, I certify my child is (check one):
Nonswimmer___Beginner___Swimmer___Advanced swimmer___
In consideration of the benefits to be derived from participation in this Crew activity, any
and all claims against the Boy Scouts of America or its local councils, Venture Crew,
chartered organization, 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 my child or to his or her property, in connection
with or incidental to Crew activity, including training or travel, are hereby expressly
waived by my child and his parents or guardians.
In the event of illness or injury occurring to my child while involved in any Crew
activity, I consent to X-ray examination, anesthesia, and/or medical or surgical diagnostic
procedures or treatment considered necessary in the best judgment of the attending
physician and performed by or under the supervision of a member of the medical staff of
the hospital/medical facility furnishing medical services. It is understood that in the
event of a serious illness or injury, reasonable efforts will be attempted to reach a parent
or guardian.
Parent/Guardian_____________________________________Date________________