TROOP 63

Permission Slip

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 BSA TROOP 63 - PERMISSION SLIP

THREE FIRES COUNCIL – CHIPPEWA DISTRICT   

ACTIVITY:__________________________________  COST:  $_____
DATE(S) OF ACTIVITY: _____________________________________
LOCATION:  ______________________________________________

DEPARTURE INFO:  ________________________________________

RETURN INFO:  ___________________________________________
CONTACT PERSON:  ______________________________________

PHONE NUMBER:  ________________________________________

+++++++++++++++++++++++++++++++++++++++++++++++++++++++

As the parent or legal guardian of ___________________________, I hereby give my permission for this child to participate in an outing with Troop 63.

I give permission to the leaders of the above unit to render First Aid, should the need arise. In the event of an emergency, I also give permission to the physician, selected by the adult leader in charge, to hospitalize, secure proper anesthesia,
order injection, or secure other medical treatment, as needed.

I further agree to hold the above named unit and its leaders blameless for any accidents that might occur during this outing except for clear acts of negligence or non-adherence to BSA policies and guidelines.

In case of emergency, I can be reached by phone at ____________ or __________________________.                                             
                      (cell)

If I cannot be reached, please contact ________________________ at ______________________________.
         (home/work/cell)

Detailed instructions on medication to be given:________________

____________________________________________________________________________________________________________________________________

Signed: ___________________________ Date: ________________ 
                   (Parent or Guardian)