Summit Bechtel Medical Form

Medical Consent and Risk Acknowledgement Form

MEDICAL CONSENT FORM

PARTICIPANT ACKNOWLEDGEMENT

In case of an emergency, I understand that every effort will be made to contact the individual listed as the emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication. Medical providers are authorized to disclose protected health information to the adult in charge, camp medical staff, camp management, and/or any physician or health care provider involved in providing medical care to the participant.

I approve the sharing of the information on this form with BSA volunteers and professionals who need to know of medical situations that might require special consideration for the safe conducting of scouting activities. I accept responsibility for providing accurate information to the Facility staff regarding any physical or medical condition I may have, knowledge or ability with respect to the Facility and any other information which may affect my safe participation.

PARENT OR GUARDIAN ACKNOWLEDGEMENT FOR PARTICIPANT UNDER AGE 18

As the parent or legal guardian of the Participant whose name appears above, I understand that, in case of an emergency involving the Participant, every effort will be made to contact the individual listed as the emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for the Participant.

I approve the sharing of the information on this form with BSA volunteers and professionals who need to know of medical situations that might require special consideration for the safe conducting of scouting activities.

RISK ACKNOWLEDGEMENT AND CONSENT FORM

(Liability Limitations, Restrictions and Responsibilities, Risk Acknowledgement, Code of Conduct Acknowledgement, Media Release)

The adventure and recreational program facilities offered by the Boy Scouts of America at The Summit Bechtel Family National Scout Reserve are designed to provide intense high adventure opportunities for participants. While safety is of paramount concern, there are risks in adventure and recreational activities which cannot be eliminated.

West Virginia law requires participants in adventure and recreational activities to follow all instructions and participate only in activities within their capabilities. Participants also assume the risk of injury or death which results from their participation.

Activity Risk Areas

• Mountain Biking and BMX – courses have a wide variety of terrain and include risks such as falling, collisions, and loss of control.

• Zip Line and Canopy Tours – require harness and fall protection equipment and training.

• Climbing and Challenge Courses – require special equipment and may involve falling or entanglement risks.

• Skate Boarding – serious injury or death may result from falls.

• Whitewater Rafting – separate warning and release form may be required.

• Firearms and Archery – hearing protection and safe handling are required.

• Aquatic Adventures – flotation devices may be required.

• Hiking and Trek Experience to Garden Ground – strenuous ascent with natural hazards.

Participant Acknowledgement Understanding of Risks

I have read and understand the information provided in this acknowledgement that summarizes the potentially dangerous elements of the Facilities at The Summit as well as liability limitations, restrictions and responsibilities pertaining to me as a participant as required by West Virginia law.

Acknowledgement of Code of Conduct

• I promise to obey the Scout oath and law.

• I will be Scout-like in how I act and treat others.

• I will attend scheduled programs and follow the unit schedule.

• I understand that alcohol, illegal drugs, gambling, lasers, and fireworks are prohibited.

• I will obey safety rules and instructions of supervisors and staff members.

• I understand that bullying, hazing, harassment, and theft may result in expulsion.

• I confirm that I have read and agree with the Code of Conduct.

Media Consent and Authorization

I hereby assign and grant to the local council and the Boy Scouts of America the right and permission to use and publish photographs, film, videotapes, electronic representation, and/or sound recordings made of me at all Scouting activities.

I authorize reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said media without limitation.

PARENT OR GUARDIAN ACKNOWLEDGEMENT FOR PARTICIPANT UNDER AGE 18

As the parent or legal guardian of the Participant whose name appears above, I have read and understand the information provided in this acknowledgement and hereby agree to allow the Participant to engage in the adventure and recreational activities with an understanding of the potentially dangerous elements of the Facilities as well as the liability limitations, restrictions and responsibilities pertaining to participants.

I confirm that I have read and agree with the Statement of Understanding and the Code of Conduct, and I have also reviewed the Media Consent and Authorization.