| PERMISSION SLIP |
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| PEOPLE IN CHARGE: Jim Kleiver and John D. McCarthy |
| ACTIVITY: Camp Rotary Cope Course |
| TIME AND DATES: Friday, September 19 thru Sunday, September 21, 2003 |
| WHERE:
Camp Rotary, 3201 S. Clare Avenue, Clare, MI 48617 |
| PHONE: (517) 386-7943 (Camp Rotary) |
| CELL-PHONE: (517) 282-6157 (Jim Kleiver) |
| MEET AT: Judson Memorial Baptist, 530 Vernon, Lansing (517.882.5961), 5:30 p.m.,
Friday, September 19, 2003 |
| PICK UP: Judson Memorial Baptist, 530 Vernon, Lansing (517.882.5961), 12:00 noon,
Sunday, September 21, 2003 |
| ON THIS OUTING WE WILL BE: The main activities will be camping on Friday and
Saturday night and participating in a
low C.O.P.E. Course
on Saturday. We will be camping at Camp Rotary. |
| COSTS: $10.00 for
low C.O.P.E. Course
; $10.00 for camping and food. |
| SPECIAL INSTRUCTIONS: Wear your Boy Scout shirt, if you have one. Dress according to
the weather. |
| EACH PERSON WILL BE RESPONSIBLE FOR BRINGING THEIR OWN PERSONAL GEAR AND FOR TAKING
CARE OF IT PROPERLY. |
| THIS PERMISSION SLIP AND THE TOTAL FEE OF $20.00 IS DUE BY:
TUESDAY, SEPTEMBER 16, 2003 |
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| "
-------Cut--------keep top portion---------return bottom portion--------cut----------
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| I GIVE PERMISSION FOR MY SON TO JOIN TROOP 272 ON THE FOLLOWING ACTIVITY: ___________________________________________ |
| ON THIS DATE: ____________________________________________________ |
| SIGNATURE OF PARENT OR GUARDIAN: ____________________________ |
| I, ________________________________________________ (print scout’s name) |
| PROMISE TO OBEY THE SCOUT OATH, LAW AND OUTDOOR CODE. |
| SCOUT'S SIGNATURE: ____________________________________________ |
| IN AN EMERGENCY, (name) _______________________________________ |
| CAN BE REACHED AT THIS PHONE NUMBER ______________________ |
| In case of Emergency, I understand every effort will be made to contact me (if an adult, my spouse or
next of kin). In the event I cannot be reached, I hereby give my permission to the physician selected
by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery,
or injections of medication for my child (or for me, if an adult). |
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