Event Leader:___________________________ Phone Number:__________________________

Troop_____________ is going on an outing: Where:______________________

______________________

______________________

Leaving on _____________________, 2001 and returning ______________________, 2001

Cost is $ _____________ which covers all expenses, including camp fees and meals.

Permission slip and Fees are due on: ____________________________ 2001

Additional Comments:

Waiver of Responsibility: I authorize participation of this scout and waive all claims against the leaders of this trip, officers, agents and representatives of the Boy Scout of America, any sponsor or members and employees of the sponsor(s). The troop Scoutmaster or Event Leader of the activity has my permission to obtain emergency medical treatment for this scout should such treatment be deemed by them to be necessary, at my expense, except as noted below.

Scouts Name _______________________________________________________________________

Guardian Signature _____________________________________________ Date:________________

I would like to go with my son on this Trip _____

Emergency Phone Numbers: (Home)________________________ (Work)_____________________

Special Instruction/ medications /needs:

----------------------------------------------- tear here ----------------------------------------------------

*** Boy Scout Outing Reminder ***

-keep this portion

__________________________ will participate in the ____________________________event.

Departure location is East Parking Lot of the MedowLand Building (By the blue trailer).

Return location is : boys will be returned to their homes.

The Troop will no later than ______:_______ AM/PM on ___________________________

The Troop will return around ______:_______ AM/PM on __________________________

Permission slip and fee $,_________________ are due on or before _________________