BOY SCOUT TROOP 255 District Camping Trip Alpine Camp January 16 th 18 th, 2015

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1 BOY SCOUT TROOP 255 District Camping Trip Alpine Camp January 16 th 18 th, 2015 Dear Parents and Scouts, The following is information for our upcoming Overnight Alpine Camping Trip Jan 16-18, MEETING: DATE/TIME: RETURNING DATE/TIME: COST: th Ave, Flushing, Queens Friday, January 16 th at 6:30 pm Sunday, January 18 th AT 12 Noon Pickup th Ave, Flushing, Queens $20 per person All Scouts MUST wear CLASS A uniform to and from camp and bring the following: BACKPACK CHANGE OF CLOTHES FIRST AID KIT HIKING BOOTS SLEEPING BAG SLEEPING MAT EXTRA SOCKS FLASHLIGHT MESS KITS PONCHO TOILETRIES/TOWEL SNEAKERS SCOUT HANDBOOK HEAVY COAT, GLOVES & HAT (DRESS FOR COLD WEATHER) Parents MUST have a notarized PERMISSION SLIP/MEDICAL FORM handed in and fully paid dues. This permission slip is required for all activities this year. SCOUTS WHO DO NOT HAND IN A PERMISSION SLIP WILL NOT BE PERMITTED ON THE TRIP. NO EXCEPTIONS. To register, hand in the tear off form below with your payment no later than Friday, January 9th I give permission for my son to attend overnight Alpine Camping trip on January 16 to 18, 2015 in Alpine, New Jersey. I have already completed and handed in a medical form: (YES/NO) Attached is payment for $ Parent s name: Signature: Date: Parent s going: please give Full Name: Can you Drive: Kind, Year, & Make of Vehicle: Owner s Name: Driver License: Liability Insurance Coverage: Liability - Each Person: $ Each Accident: $ Property Damage: $ How many additional children can drive in addition to your son: (NO WINTER COAT, NO TRIP; YOU WILL BE SENT HOME)

2 Activity Consent Form and Approval by Parents or Legal Guardian This form is recommended for unit use to obtain approval and consent for Tiger Cubs, Cub Scouts, Webelos Scouts, Boy Scouts, Varsity Scouts, Venturers, and guests (if applicable) under 21 years of age to participate in a den, pack, team, troop, or crew trip, expedition, or activity. This form is required for use with flying permits and should be attached to the flying permit application. It is recommended that parents keep a copy of the form and contact the tour leader in the event of any questions or in case emergency contact is needed. Additional copies of this form along with the Guide to Safe Scouting are available for download from Scouting Safely at First name of participant and middle initial Last name Address Birth date (month/day/year) / / Age during activity Additional address (need street address if you have a P.O. box) City State Zip Has approval to participate in (Name of activity, orientation flight, outing trip, etc.) From to. (Date) (Date) o Without restrictions o Special considerations or restrictions: Hold Harmless Agreement I understand that participation in the activity involves a certain degree of risk. I have carefully considered the risk involved and have given consent for myself or my child to participate in the activity. I understand that participation in the activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation. In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant s parents or guardian, and/or determination of the participant s ability to continue in the program activities. Participant s signature Date Parent/guardian printed name Parent/guardian signature Date Area code and telephone number (best contact and emergency contact) (for use in sharing more details about the trip or activity) Contact the adult tour leader with any questions: Name Phone Printing

3 BOY SCOUT TROOP 255 PERMISSION/MEDICAL FORM (PARENT MUST COMPLETE AND PROVIDE ALL INFORMATION -- PLEASE PRINT) I give permission for my son to participate in all scout activities, including overnight camping trips, during the Sep/2014 Aug/2015 season. In case of an emergency you can reach me at: HOME PHONE WORK/CELL If I cannot be reached, please contact (NAME) HOME PHONE WORK/CELL In case of a medical emergency, I give permission to Scout Leaders Carl Camurati, Gene Carter, Dit Cheung, Anthony Drew, Donald Hue, Tek Fong Lee, Marc Natole, Howard Schubert, Denis Williams and Bill Young to authorize emergency medical treatment for my son. FAMILY DOCTOR TELEPHONE MEDICAL HEALTH INSURANCE CARRIER(S) AND POLICY NUMBER(S) -- Please list any and ALL allergies to medication, food, plant, insect toxin or any other condition that may require special care, medication, etc. Please list any and ALL physical restrictions and other vital information. Date of Last Tetanus Shot I understand that participation in the Scout program offered by Troop 255, through the Greater New York Council, Boy Scouts of America, may involve a certain degree of risk. I have carefully considered the risk involved and hereby give consent to my son named above to participate in the program. PARENT S NAME (PRINT) Parent's Signature Date This form MUST be notarized and accompanied by a BSA medical form.

4 12/27/2014 Google Maps Drive 23.9 miles, 38 min Directions from th Ave to Alpine Scout Camp th Ave Flushing, NY Get on Cross Island Pkwy from Utopia Pkwy and Francis Lewis Blvd 3.2 mi / 10 min 1. Head east on 46th Ave toward Auburndale Ln 0.2 mi 2. Take the 3rd left onto Utopia Pkwy 1.1 mi 3. Slight left onto Francis Lewis Blvd 1.3 mi 4. Turn right onto 16th Ave 5. Take the 1st left onto 159th St 427 ft 6. Turn right onto Cross Island Pkwy 253 ft 7. Take the 1st left onto 160th St 249 ft th+Avenue,+Flushing,+NY/Alpine+Scout+Camp,+441+US+Highway+9+W,+Alpine,+NJ+10522/@ , 7 1/3

5 12/27/2014 Google Maps 8. Take the 1st left onto Cross Island Pkwy 0.3 mi 9. Slight left onto the Cross Is. Pkwy N ramp Take I-678 N, I-95 S and Palisades Interstate Pkwy N to Orbach Way in Alpine. Take exit 3 from Palisades Interstate Pkwy S 20.7 mi / 27 min 10. Merge onto Cross Island Pkwy 0.5 mi 11. Take exit 36N to merge onto I-678 N toward Whitestone Bridge/Bronx Partial toll road 2.7 mi 12. Take the I-95 N exit toward New England 13. Keep left at the fork to continue on Exit 195-W, follow signs for Interstate 95 S/Interstate 278 W/G Washington Br/Manhattan 0.3 mi 14. Keep right at the fork, follow signs for Interstate 95 S and merge onto I-95 S 5.1 mi 15. Keep left at the fork to continue on I-95 S/Trans-Manhattan Expy, follow signs for U.S.1 Continue to follow I-95 S Entering New Jersey 1.8 mi 16. Take exit 74 toward Palisades Parkway 0.6 mi 17. Continue onto Palisades Interstate Pkwy N 9.2 mi 18. Take exit 3 on the left toward RT 9 W 371 ft 19. Merge onto Palisades Interstate Pkwy S th+Avenue,+Flushing,+NY/Alpine+Scout+Camp,+441+US+Highway+9+W,+Alpine,+NJ+10522/@ , 7 2/3

6 12/27/2014 Google Maps 20. Take exit 3 for US-9W toward Scout Camp Continue straight onto Orbach Way 105 ft / 51 s Alpine Scout Camp 441 US Highway 9 W, Alpine, NJ These directions are for planning purposes only. You may find that construction projects, traffic, weather, or other events may cause conditions to differ from the map results, and you should plan your route accordingly. You must obey all signs or notices regarding your route th+Avenue,+Flushing,+NY/Alpine+Scout+Camp,+441+US+Highway+9+W,+Alpine,+NJ+10522/@ , 7 3/3

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