PARENT/GUARDIAN PERMISSION SLIP

(Print, Complete, Sign and Send form to troop leader or event coordinator.)





My daughter _________________________________ has permission to participate in

________________________________________________________________________
(Name of Event and Date)
She is in good physical condition and has not had any serious illness or operation since her last health examination.
During the activity, I may be reached at:
Address: __________________________________________________
Phone:(_____)__________________.
If I cannot be reached in the event of an emergency, the following person is authorized to act in my behalf:
Name and address: ________________________________________________________________________
________________________________________________________________________
Relation to participant: _____________________________________
Phone #: (_____)_____________________
Physician's name: _________________________________________
Phone #: (_____)_____________________
Additional remarks:



(In addition to this form, a medical history signed by the parent within the current year is required for water sports, horseback riding, skiing, hiking, non-contact sports such as tennis or gymnastics, and other such physically demanding activities. Check with your Council for suggested medical history form.)


________________________________________________________
Signature of Custodial Parent/Guardian and Date

P-8 Rev. 9/11/00