PARENT/GUARDIAN PERMISSION FORM


 Troop _______________ is planning a ______________________________________________
 Date: __________________________________ Time: _______________________________
 Location: _____________________________________ Phone No. (_____) _________________
 Leaders Name: ________________________________ Phone No. (_____)__________________
 ARRANGEMENTS FOR TRANSPORTATION:
 Time & Place of Departure: _____________________________________________________
 Time & Place of Return : _______________________________________________________
 Mode of Transporation: ________________________________________________________
 Leaders accompanying girls:
  Name: ________________________________ Name: _______________________________
 Troop First Aider (Adult) ________________________ Date Certification Expires: ____________
 Each girl will need: EXPENSES: _________________________________________________
 Other equipment and clothing: ___________________________________________________
 In case of emergency, the leader will notify: _________________________________________
Phone (_____)_______________________ who will immediately notify parents.


_________________________________________
 Leaders' Signature
 (Cut off and return below portion to troop leader)
 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
 My daughter, ______________________________________, has permission to participate in
 ______________________________________________________. 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 & Address: ______________________________________________________________
 Relation to participant: ___________________________ Phone # (_____)___________________
 Physician : ____________________________________ Phone # (_____)___________________
 Addtional 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 activites. Check with you Council for suggested medical history form.
 
 _________________________________________________________
Singnature of Custodial Parent/Guardian and Date
 P-8