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Troop/Crew 146 Activity Release Form
 
___________________________ has my permission to go
 
with Boy Scout/Crew 146 to __________________________
 
on the following date(s)____________________________.
 
I give the leaders of Boy Scout Troop/Crew 146 authorization to secure medical
 or dental attention for the listed individual(s), if needed or considered necessary,
 during the date(s) listed above.
 
Parent or Guardian_________________________________
 
Date(s)___________________________________________
 
Phone-Home______________________________________
 
Phone-Work______________________________________
 
Insurance Carrier__________________________________
 
Policy Number____________________________________
 
Please list any current medical conditions or special instructions, including medications, on back.
*****************************************************
___________________ has my permission to leave early with
 
_______________________ at _______________ time on the
 
following date(s)____________________.
*****************************************************
SIGNATURE OF PARENT OR LEGAL GUARDIAN:
 
___________________________________________.















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