Permission Slip

PEOPLE IN CHARGE: John McCarthy, Bret McAtee

ACTIVITY: Optimist Youth Camp/Bertha Brock Outing

TIME AND DATES:Friday-Saturday, January 3-4

WHERE: Optimist Youth Camp, just west of the corner of Kinsel and Wheaton Rds., north of Charlotte, and west of Hwy. M-50 (call McCarthys at 699-8179 if you need further directions)

PHONE: (emergency only!) 543-7925 for the caretaker of the camp.

MEET AT: at Optimist Youth Camp (or arrange your own carpooling), Friday, January 3, 3:30 p.m.

PICK UP: approximately 4:00 p.m., Saturday at Charlotte Christian Reformed Church

ON THIS OUTING WE WILL BE: camping in a rustic cabin (bunk beds- no mattresses), sledding at Bertha Brock (bring warm winter clothing and sled), games, etc.

COSTS: $7.50 for meals; $2.50 for lodging.

SPECIAL INSTRUCTIONS: Wear your Boy Scout shirt, if you have one. Dress according to the weather. Prepare for cold 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 $10.00 IS DUE BY: Fri., January 3, 2003

" -------Cut--------keep top portion---------return bottom portion--------cut---------- "

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).