Participant Name: _______________________________________________________
Email Address: __________________________@_____________________________
Address: ______________________________________________________________
City: _______________________________ State: ___________
Zip: _____________
Troop: _____________
Date of Participation: ____________________
Age: ________ Sex:
________ Date Signed: __________________________
I, the undersigned, hereby give permission for my son’s/daughter’s
participation on the C.O.P.E. course
at Trexler Scout Reservation, Minsi Trails Council,
Boy Scouts of America. I am aware the course is in an
outdoor environment and the activities are physically
demanding in nature, presenting a greater than normal
risk of injury.
I understand that the C.O.P.E. staff is trained and
will take all necessary precautions to ensure safety
while the course is in normal operation. I have read
the Pre-Course Information Sheet and Clothing List provided
by C.O.P.E.
I hereby release the Minsi Trails Council, Boy Scouts
of America, C.O.P.E., its director and instructors from
all legal responsibility for injuries resulting from
this course.
Parent / Legal Guardian : ___________________________________
Date: __________
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