We need this information in our file for both your son and for any parents registered with the troop as Adult Leaders for any participation in events.
Please return by our meeting on May 11. If you have any questions or concerns, please see Mr. Chase, or contact us at troop2weymouth@gmail.com
Troop 2 Member Quick Reference Card
All information provided will be held
in confidence, and is required to ensure we can contact you in an emergency and
take care of your son during events.
Contact Information
|
Name
|
|
|
Date of
Birth
|
|
|
Address
|
|
|
Telephone
|
|
|
Email(s)
|
|
|
Parent
Names
|
|
|
Parent
Telephone
|
|
|
Any
custodial restrictions or alternate contacts?
|
|
|
Parent
Employer Name
|
|
Medical Information
|
Health
Insurance Carrier
|
|
|
Policy
Number
|
|
|
Primary
Care Physician
|
|
|
Address
|
|
|
Telephone
|
|
|
Allergies
|
|
|
Special
Considerations (critical physical and
medical history, medications, asthma, foods, etc)
|
|
Notes
|
|
|
|
Please let
us know if YOU have any questions or concerns
|
|
|
Permission
to transport, photograph, post photos on the web, etc (please note any
restrictions)
|
|
