Boy scout troop 201 – olmsted falls

Boy Scout Troop 201 – Olmsted Falls
Consent, Authorization and Release

I consent to my son, _____________________________ participating in the activities
of the Boy Scout Troop 201 from the date of this release through December 31,
2012, or until this consent is revoked in writing.
I authorize the Troop 201 adult leaders to seek, select and implement emergency
medical, dental, surgical and hospital treatment for my son, and further authorize
any licensed physician or dentist to treat him as the physician or dentist deems
I release Troop 201 adult leaders from any liability arising from such selection and
implementation of emergency treatment, and promise to hold them harmless and
reimburse them for any liability arising there from. The adult leaders or Troop 201
shall advise me of my son’s illness or injury as soon as possible. In addition Troop
201 adult leaders may return my son from treatment to camp or home if I am not
Hospitalization Coverage_________________________ Group __________________

Code_________________________ Contract/ID/Record No. ____________________
Blood Type (if known) _______________ Faith ______________________________
Date of last Tetanus vaccination (very important) _____________________________
Residence address__________________________ Home Phone __________________
__________________________ E-mail_______________________
Father or legal guardian _____________________ Work Phone _________________
Cell Phone___________________
Mother or legal guardian ____________________ Work Phone __________________
Cell Phone___________________
Other Emergency Contact__________________________ Phone _________________
Relation to Scout_________________________________________________________

__________________________________________________ ____________________
Signature of Father or Legal Guardian

__________________________________________________ ____________________
Signature of Mother or Legal Guardian Date

(Please print legibly)
Boy Scout Troop 201 – Olmsted Falls
Authorization to Administer “Over the counter medicine”

I _____________________________________________ (mother) and _______________________________________________ (father) hereby give permission to the adult leaders of Boy Scout Troop 201 permission to administer the following “over the counter”medications/ or materials to my son. Mother’s Initial Mother’s initial Father’s Initial
I specifically do not want the following medications or items administered to my son.
Please complete the reverse side of this form for prescription medications to be
administered. Sign and date both sides of the form. Whenever possible both parents
should sign the form.
_____________________________________ Mother’s Signature __________ Date
_____________________________________ Father’s Signature ___________ Date
(Please print legibly)


Microsoft word - pregnant mare-foal care.doc

SERVICES VETERINAIRES AMBULATOIRE EQUIN EQUINE AMBULATORY VETERINARY SERVICES Dre Alix Serapiglia Rappel: choses à faire-penser avant accouplement / insémination Examen reproducteur de la jument et examen physique general Durée de gestation: 335-345 jours en moyenne Règle générale, les juments gestantes sont traitées de la même façon que les autres chevaux jusqu’à envir

Microsoft word - lbl-0869 rev 1 - aigisrx r instructions for use _us_.docx

TYRX® Brand AIGIS Rx R Fully Resorbable Antibacterial Envelope (Antibacterial, Polymer-Coated Bioresorbable Envelope Containing the Antimicrobials Rifampin and Minocycline) Manufactured and distributed by: TYRX, Inc. STERILE: Contents sterile unless package has been opened or damaged. Single Use Only. Do Not Resterilize. CAUTION: Read instructions prior to use. Rx Only

Copyright © 2010-2014 Medical Articles