Permission Slip

PEOPLE IN CHARGE: Gary Cunningham, John McCarthy

ACTIVITY: Pokagon State Park Toboggan Outing

TIME AND DATES:Friday-Sunday, February 14-16, 2003

WHERE: Anthony Wayne Scout Reservation

PHONE: (emergency only!) 260-475-5099 for the campmaster on weekends.

MEET AT: Charlotte Christian Reformed Church, Friday, February 14, 6:00 p.m.

PICK UP: approximately 12:00 noon, Sunday at Charlotte Christian Reformed Church

ON THIS OUTING WE WILL BE: camping in a "treehouse" (bunk beds- no mattresses), tobogganning at Pokagon State Park (bring warm winter clothing)

COSTS: $30.00 for transportation, meals, lodging, and toboggan run.

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 $30.00 IS DUE BY: Tuesday, February 11, 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).