Hunter Education/ Rifle and Shotgun Merit Badge

Troop 178 Waukee, Iowa Hunter Education/ Rifle and Shotgun Merit Badge September 2011

Boy Scout Troop 178 will be participating in the shooting program conducted by Central Iowa Shooting Sports, Inc. holding a Hunter Safety Campout at its shooting complex near Indianola from Friday, September 16 to Sunday, September 18. We will leave promptly at 6:00pm Friday from the Waukee City Hall parking lot and will return to the same location at 11:00am on Sunday.

The cost of the campout is $70 per participant. This fee includes use of guns, ammunition, targets, eye protection, hearing protection, instructors, meals, and transportation. We will be camping outdoors. Please plan accordingly with appropriate boots, clothing, rain gear and sleeping bags.

Please return the completed lower portion of this form to Darrel Greifzu, Assistant Scoutmaster, no later than Sunday, August 28. You may keep this top portion for future reference. If you wish to mail the form and payment (payable to Troop 178), please send to Darrel Greifzu at 6355 Orchard Dr, West Des Moines, IA, 50266.

This is to certify that ______has my permission to accompany Boy Scout Troop 178 to the Hunter Safety Campout September 16 - 18 at Central Iowa Shooting Sports near Indianola. I hereby release Darrel Greifzu, Assistant Scoutmaster, and all other registered troop leaders and drivers from any liability and any and all claims for injuries or accidents which might be received during this trip either at the destination or in traveling to and from this destination. The adult leader or his designated assistant(s) have my permission to administer over-the-counter medicine(s) as deemed necessary and/or seek medical help if necessary for my child in the event of an emergency.

Parent/Guardian Signature:______Date:______

While my child is attending this outing I may be reached at:

Day time telephone #:______Evening telephone #:______

Cell#:______

Address:______

Emergency contact: Name:______

Address:______Phone#:______

Please list any special medical information or allergies to medication. All medication must be accompanied by written directions for dispensing. ______I will be available to provide transportation to the campout. ( ) Yes ( ) No I will be available to provide transportation from the campout. ( ) Yes ( ) No I will be available to pull the troop trailer to the campout. ( ) Yes ( ) No I will be available to pull the troop trailer from the campout. ( ) Yes ( ) No I will be going along on the campout and help as a chaperone. ( ) Yes ( ) No Select One Course:

Hunter Education/ Rifle/ Shotgun ____ Winchester/ NRA ____

Office use only: Date Paid Amount Check # Cash Rcd.By Shooting Program/ BSA Rifle and Shotgun Merit Badge Permission Slip

This is to inform you that our Troop will be working on the Rifle and Shotgun merit badges, Iowa Hunter Education, and the Winchester/ NRA Marksmanship Qualification Program at the Central Iowa Shooting Sports Inc. Complex at 19444 Hwy 65 south of Indianola, Iowa.

The troop will be shooting live ammo with real guns including 22LR rifles and 12 and 20 gauge shotguns. All shooting will be supervised by NRA certified instructors. No horseplay or unsafe behavior will be tolerated. Any scout or adult engaging in unsafe gun safety behavior will be subject to immediate expulsion from the class and the shooting complex.

If you have any questions, you may call Randy Jimenez, Chief Instructor at (641) 466-3651. Please sign the form below and return it with the Troop permission slip.

I/ We give our permission for: ______to take part in the shooting program at Central Iowa Shooting Sports, Inc. with BSA Troop 178.

Parent or Guardian ______Date: ______