BSA Troop 807

Hayward, California

Medical Release         Scout Binder Pages

Scouts Name: _________________________________________________________ Unit #: 807

The undersigned do hereby authorize the San Francisco Bay Area Council's Officers or Representatives, or such substitutes as may designate, as agent for the undersigned to consent to any X-ray, examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care for the above named minor which is deemed advisable by and to rendered under the general and supervision of any physician and surgeon, licensed under the Provision of Medicine Practice Act, or of any dentist licensed under the Dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital, Scout Camp, or elsewhere.

It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable.

This authorization is given pursuant to the provision of SECTION 25.8 of the CIVIL CODE OF CALIFORNIA.

The authorization will remain effective while the above named minor is en route to or from, or involved or participating, in any program or activity of the San Francisco Bay Area Council, Boy Scouts of America, Troop 807, unless revoked in writing by the undersigned, and delivered to the aforesaid agent.

Date: ___________________________ Father or Guardian: _________________________________

Witness By: ______________________ Mother or Guardian: ________________________________

Home Address: ___________________________________________________________

Home Phone: (_____)______________________________________________________

Business Phone: (_____)____________________________________________________

Family Insurance Company: ______________________ Policy No.: ___________________

Family Physician: ______________________________ Phone No.: (_____)_____________

06/24/97

Camping Diary Page

Service Project Hours Diary Page

List the badges and dates they were earned in the spaces below. It takes 6 merit badges (4 of them Eagle required) to complete requirement #3 for the Star Rank. It takes 5 additional merit badges (3 of them Eagle required) to complete requirement #3 for the Life Rank. It takes a total of 21 merit badges (12 of them Eagle required) to complete requirement #3 for the Eagle Rank.

List each night you camp in the spaces below. It takes 20 nights of camping to complete Requirement 9A for the Eagle-required Camping Merit Badge. It takes 25 nights of camping to earn the District's Special Patch.

List the hours spent working on service projects in the spaces below. It takes 1 hour of service to complete requirement #4 for the Second Class Rank. It takes 6 hours of service to complete requirement #4 for each of the Star and Life Ranks. (Service hours for Eagle Rank will be tracked on a separate form.)