Cub Scout Overnight Parental Consent

Fill in once · receive the completed forms as PDF attachments

Completing this form submits two signed documents to the organizer: the Archdiocese Field Trip Parental Consent & Indemnity Agreement (Overnight) and the matching Adult Off-Site Liability Waiver for the attending parent/adult.

Participant Information

First name *

Middle initial

Last name *

Date of birth *

Age during activity *

Gender (overnight form)

Home Address & Parent/Guardian Contact

Street address *

City *

State *

Zip *

Parent/guardian full name *

Parent/guardian email *

Home phone (primary / emergency) *

Business phone (overnight form)

Attending Adult ADULT

Is an adult attending this trip? If you (or another adult) will be going along with the Scout, enter the adult’s name below. An Adult Liability Waiver PDF will be generated and attached to the submission email for that adult. Leave blank if no adult is attending.

Name(s) of parent/adult attending *

Attending Adult — Liability Waiver Info ADULT

Attending adult’s allergies and/or other health conditions (shown to doctors in case of emergency; leave blank if none)

Daytime phone (for the attending adult; leave blank to use home phone)

Night-time phone (for the attending adult)

Insurance ID # (leave blank to reuse policy # from above)

Emergency contact, insurance carrier, and policy number from the main form will be reused on the waiver unless overridden above.

Emergency Contact & Medical Information

Used by the overnight field trip form.

Emergency contact — name & relationship

Emergency contact phone

Family doctor

Family doctor phone

Health plan carrier

Policy #

Allergic reactions (medications, foods, plants, insects, etc.)

Medically prescribed diet

Physical limitations

Chronic homesickness, emotional reactions to new situations, sleepwalking, bedwetting, fainting

Recent contagious disease exposure?

If yes, list date and disease/condition

Special medical conditions we should be aware of

Activity / Event Details

Name of parish/school or Scouting unit *

Activity / event name * (also used as "Type of event" on overnight form)

Student cost ($) (overnight form)

From date *

To date *

Destination (overnight form)

Est. departure time

Est. return time

Mode of transportation

Individual in charge / adult leader

Leader phone

Leader email

Medical Authorizations

The overnight form has several optional medical-authorization signature blocks. Select each one you want to apply — your parent/guardian signature below will be applied to every authorization you check.

Emergency medical treatment — In the event of an emergency, I give permission to transport my child to a hospital for emergency medical or surgical treatment and wish to be advised prior to further treatment. Call me if my child becomes ill (other medical treatment) — I want to be called as soon as reasonably possible if my child shows symptoms such as headache, vomiting, sore throat, fever, or diarrhea. Non-prescription medication — I grant permission for non-aspirin products (e.g. acetaminophen, ibuprofen, throat lozenges, cough syrup) to be given to my child if deemed appropriate.

Medication status

My child IS taking medication and will bring it (well-labeled). My child is NOT taking medication. No medication may be administered unless life-threatening.

Special instructions (anything else the organizer or chaperones should know about this participant — optional)

Informed Consent & Release Agreements I have read and agree to all of the above. I understand my parent/guardian signature below will be applied to every required signature block on the form and to each medical authorization I selected.

Signature

Parent/guardian signature * (applied to every required signature block on the form)

Sign above the line

Date *