While striving to insure a wholesome,
safe, and closely supervised environment for our youth in it’s care, the
Pennsylvania-Delaware District Royal Rangers cannot be held liable for any
unforeseen and/or unforeseeable accidents which may occur during the course of
any activity. Responsible leaders, persons, and acting agents transporting on
behalf of the Royal Rangers ministry assume no personal liability in case of
accident or sickness.
________________________________________
Activity To Take Place
________________________________________________________
Where Activity Is To Take Place
___________________________
Date
PLEASE
MAKE NOTE OF TIMES AND DATES.
Return
Date and Time: ___________________________________________________________
I here by allow my son,
____________________________________________,
To
attend and participate in the above listed activity. (Please note that an Emergency
Medical Form must accompany this Permission slip. Only one Emergency
Medical form needs to be filled out per year and is good from January 1 to
December 31 of that year. Any change throughout the year is your responsibility
to let us know and a new Emergency Medical form filled out with the change on
it.) I the undersigned parent and/or guardian of the above named child, a child
under the age of eighteen (18), do herby authorize and consent to any x-ray
examination, anesthetics, medical or surgical diagnosis, treatment, surgery,
and hospital care which is deemed admissible by any physician, surgeon, or
hospital personnel who may treat my child. It is understood that this
authorization is given in advance of any specific diagnosis in order to provide
appropriate care for my child. I waive the rights to specific consent to any
and all such diagnosis, treatment, surgery, or hospital care that the
physician, in the exercise of his/her judgment, may deem needed.
__________________________________________
______________________
Signature of Parent and/or Guardian Date Signed