Boy Scouts of America Lovett Troop 304 - Boy Scout Troop 304 ...

Medical
Release Form
Troop 304, Cub Scouts of America
The Lovett School
Kevin Link - Scoutmaster
www.lovett304.com
Be Prepared – That is the Scout motto and that is how we will conduct all
activities. Our Troop requires a Medical Release Form for each Scout who
participates in Troop activities. Please use the form below to add or change your
information. This form is available from the Troop website: www.lovett304.com.
Medical Release Form
Please print all information except signature
I, ______________________________ (parent/guardian’s name), hereby give permission
for any and all medical attention administered to my son _______________________ in
the event of accident, injury, sickness, etc. under the direction of the person(s)listed
below, until such time as I may be contacted. I also assume the responsibility for the
payment for any such treatment. This release is effective for the period of one year from
the date given below.
Scout Full Name:
Scout date of birth:
Parent or Guardian names:
Home address:
Parent/Guardian Home Phone:
Parent/Guardian Cell Phone:
Health Insurance Company
Policy Number
Physician
Physician Address
Physician Phone
Known Scout Allergies
In case I cannot be reached, any of the following persons are designated to act on my behalf:
1. Scoutmaster: Kevin Link
2. Any Troop 304 Committee Member or adult leader of a Troop-sponsored event in which my son
Troop Guide 26 Be Prepared!