Permission Slip

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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		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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