INFORMED CONSENT AND
HOLD-HARMLESS AGREEMENT

I understand that participation in the______________________________________________________   
                                                     (activity)
offered through the Indian Nations Council, Boy Scouts of America, involves a certain degree of risk.  

I have carefully considered the risk involved and have given ____________________________________
                                                                                                         (scout's name),  
      
my consent to participate in ______________________________   on
______________________________                                           
                                 (activity)                                                          (date)

This form must have parents/guardian signature(s):

       ____________________________________           ____________________________________     
                                                                                                                              
Name (Please Print)                                                    Name (Please Print)

       ____________________________________           ____________________________________     
                                        
Signature                                                               Signature

   _____________________________________         ____________________________________         
                                                                                                                            
Date                                                                      Date

Telephone number (      ) ________________________