Permission Slip

Troop 403 Event Campout DATE, 2010

Event: Eric Moe’s Eagle Scout Project

Date: May 12th

, 2012

Cost: Free

Depart: Kocurek Elementary 9:00 AM

Return: Kocurek Elementary 3:30 AM

I understand that by allowing my child to attend this function I am granting the responsible adult(s) permission to

render or seek medical help as required. (Return the section below to Troop 403)

TROOP 403 AUSTIN, TEXAS

Scout, (name)

Has permission to attend the event/campout. I understand that by allowing my child to attend this function I am

granting the responsible adult(s) permission to render or seek medical help as required.

Quick Medical Notes My son has the following allergies (Medicines/food/insects) or conditions:

Does he carry an inhaler or Epipen? Yes No

The adult leaders have my permission to give my son any over the counter medication as needed, such

as Tylenol, Motrin, or Benadryl etc. Yes No

My son is currently taking the following medications:

Special Notes:

Transportation will be provided by the troop in both directions unless noted here and acknowledged by the event champion/designee. Parent / Guardian will deliver pick up this scout. Parent or Guardian’s Signature Date

Phone Number (where you will be during this event) Alternate Phone