PERMISSION FORM
I_________________________________________
(print parent or guardian’s name)
AS PARENT OR LEGAL GUARDIAN OF SCOUT:
___________________________________________,
DO HEREBY GRANT MY PERMISSION FOR HIM TO ATTEND THE FOLLOWING TROOP 5 EVENTS:
23 APR THRU 25 APR 2004: FREEDOM TRAIL - BOSTON MASS
CAMP SAYRE, MILTON MASS.
21 MAY THRU 23 MAY 2004: CYCLING CAMPOUT
HICKORY RUN STATE PARK, PENNSYLVANIA
04 JUN THRU 06 JUN 2004 BLYDENBURGH COUNTY PARK
SMITHTOWN, NEW YORK
27 JUN THRU 04 JUL 2004 YAWGOOG SCOUT RESERVATION
ROCKVILLE, RHODE ISLAND
IN CASE OF EMERGENCY I CAN BE REACHED AT TELEPHONE #:
[ ]________________________________ DAY
[ ]________________________________ EVENING
AN ALTERNATE CONTACT WOULD BE:
______________________ @ TELEPHONE # [ ] ___________________
RELATIONSHIP ____________________________________________
IN THE EVENT I CANNOT BE REACHED IN AN EMERGENCY, I HEREBY GIVE PERMISSION TO THE PHYSICIAN SELECTED BY THE SCOUT PERSONNNEL IN CHARGE TO SECURE PROPER TREATEMENT FOR MY CHILD.
_______________________________ ___________________
signature date
