Boy Scout Troop 33

Saint Paul’s Church

714 Herbertsville Road

Brick, NJ 08724

PERMISSION SLIP

I hereby give permission for my son _____________________________ to attend _________________________________ on ____________ to ____________.  In event of an emergency please contact the following authorized persons.

1. Name ____________________________ 2. Name ____________________________

Address __________________________ Address __________________________

Phone # __________________________ Phone # __________________________

Relationship to your son _______________ Relationship to your son _____________

I authorize the adult leaders of Troop 33 to take appropriate action necessary to procure prompt medical treatment for my son should the need arise. In the event of an emergency, I give permission to the physician selected by the leader in charge, to administer proper emergency care.

My son has the following medical conditions that the adult leaders must be aware of.

_____________________________________________________________________________________

Parent Signature ___________________________________

Date________________

Please circle all that apply.

Adult can drive                             To Activity         From Activity Both Ways

Adult can participate in activity                         Partial Time Full Time