Permission Slip

PEOPLE IN CHARGE: Gary Cunningham, John McCarthy

ACTIVITY: Mawanjidiwin Spring Camporall 2004

TIME AND DATES:Friday-Sunday, May 14-16, 2004

WHERE: Fox Memorial Park, Potterville

PHONE: (emergency only!) (517) 699-8179

MEET AT: Olivet Baptist Church, Friday, May 14, 6:30 p.m.

PICK UP: approximately 1:00 p.m. Sunday at Olivet Baptist Church

ON THIS OUTING WE WILL BE: camping in tents at Fox Memorial Park, Potterville. The theme of the camporee is Forestry.

COSTS: $15.00 for meals and program

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 $15.00 IS DUE BY: Tuesday, May 11, 2004

" -------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).