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McKinney Falls Permission Slip
As the parent or legal guardian of _________________________ , I hereby give my permission for this child to
participate in an outing with Troop 1020.
Departure Time:
6:30 pm
Date:
10/10/04
Pilgrim Luthern
Return Time:
1:00 pm
Date:
10/12/04
Pilgrim Luthern
Activity:
Campout
McKinney Falls State Park
I give permission to the leaders of the above unit to render First Aid, should the need arise. In the event of an emergency,
I also give permission to the physician, selected by the adult leader in charge, to hospitalize, secure proper anesthesia,
order injection, or secure other medical treatment, as needed.
I further agree to hold the above named unit and its leaders blameless for any accidents that might occur during this
outing except for clear acts of negligence or non-adherence to BSA policies and guidelines.
My son's current Medical Release and Physical is on file with Troop 1020.
In case of emergency, I can be reached by phone at ____________________ or ____________________.
If I cannot be reached, please contact _________________________ at ____________________.
Signed: ______________________________ Date: _______________
(Parent or Guardian)