Premission Slip Text
Olan Watkins (o.watkins@GENIE.GEIS.COM)
Thu, 30 Jun 1994 22:36:00 UTC
TROOP 135 - WESTERN HILLS METHODIST CHURCH
PARENTAL PERMISSION
I understand that my son (complete name) ___________________
______ will be participating with Troop 135 Spring Camporee
at Sid Richardson Scout Camp from Friday 8 April to Sunday 10
April. My son is in good physical condition at present and
hasn't had any serious illness or operation since his last
health exam. If he doesn't feel well, I will make sure he
doesn't attend. In the event of an emergency and I can't be
reached, I give my permission to the physician, selected by
the adult leader in charge, to hospitalize, secure proper
anesthesia, or to order injections or surgery for my son.
I also agree that in the event my son is sent home from the
camp because of dangerous or improper behavior, I will drive
to the location of this activity and take my son home.
Signature __________________________________ Date __________
Printed Name _______________________ Relationship __________
Emergency Phone Numbers ____________________________________
I agree to abide by the Troops rules of camping and I under-
stand that I will be sent home if my behavior is dangerous or
improper.
Scout's Signature __________________________ Date __________
Date of last Tetanus Booster _______________
The Scout is allergic or sensitive too _____________________
____________________________________________________________
What, if any, medication is Scout taking? __________________
____________________________________________________________
Do you want leader to carry medication? Yes _____ No _____
Any other information leader should be aware of? ___________
____________________________________________________________
Medical Insurance Information: Company _____________________
Policy Number ___________________ Other ____________________
Scouts full name and address _______________________________
____________________________________________________________
Scout's physician, Phone number, and Address _______________
____________________________________________________________
Other Emergency Name(s) and Phone Numbers __________________
____________________________________________________________
Terry Howerton Sakima Group, Inc. SCOUTER Magazine Kansas City | 
