Kayaking Permission Form 

PARENTAL PERMISSION FORM

General Information

For High Risk Activities

Troop/Group____1499_______     Activity Date _Saturday, June 1, 2002

Acitvity_____Kayaking at Activity

Location_Piscataway Creek, Fort Washington, MD__________________

Departure time _______5:00 pm__________________Place ____Waples Mill Elementary

Return time _______10:00 pm___________________Place _home__________

Transportation ____Parents_________________________Cost _$35.00______

Each child should:_Change of shoes and clothes. Eat dinner before leaving and a snack will be provided for the way home._

 Leader ___Susan Davis_____________________Phone  703 620-3266__________

Adults attending __TBD_______________ Phone __________

Emergency contact_____Susan Davis______________Phone ____703 701-2778_(beeper)____

Please complete the form below and return by____April 30 to Mrs. Davis

 Ö  if this is a High Risk Activity

For programs that include horseback riding, white water rafting, canoeing, caving, rock climbing, rappelling, swimming, or other physically strenuous or hazardous activities, parent or guardian should recognize that these activities can be dangerous and that some times serious injuries may occur.

For Sensitive Issue Activities

Ö if this is a Sensitive Issue Activity

Please discuss this activity with your child.  Attendance is optional for all or part of the activity.  However, it is the parent or child’s responsibility to communicate to the leader your needs prior to the activity date.

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General Information

For High Risk Activities

I am the parent/guardian of __________________________________________________

I have read the description of the activity planned for ____June 1, 2002________

                                                                                                   date

I will be responsible for ensuring that my child brings the required equipment and attends only if in good physical condition.

I give special permission and/or instructions for the following medication

_____________________________________________________.  This medicine will be

properly labeled and given to the adult First Aider.

Mother/guardian_____________________________________Phone ________________

Father/guardian______________________________________Phone ________________

Emergency contact ___________________________________Phone ________________

I have read the attached description of the activity planned and I understand that my child will be exposed to above normal risk of injury.  I sustain that to the best of my knowledge, my child has the maturity, required skills and physical ability to participate in the activity described above.

*Initial_____________Date____________

For Sensitive Issue Activities

I have read the attached description of the activity planned.  I understand that my child will be exposed to issues and discussions that are, or could be, considered to be of a sensitive or controversial nature.  I have discussed this activity with my child and am confident of her/his maturity/ability to participate.

*Initial ______________Date___________

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I give my permission for my child to participate YES Ö     NO Ö

Signature ___________________________________________Date_________________

*Parent: If this is a high risk or sensitive issue activity, please initial and date in appropriate box.

For Photographs

I give my permission for my child to be photographed and allow GSCNC to release said pictures for publicity purposes. 

                YES Ö      NO Ö