Generic permission slip

Girl Scouts of Central Texas: Oak Hill Service Unit Troop 2041 Parent Permission Slip


RETURN THIS TO TROOP LEADER at [date, time]

My daughter ____________________________ has my permission to attend the Troop 2041 Winter Party on 12/20/13 to 12/21/13.

We will gather at 6:00 p.m. on 12/20 at the Elliott Barn. Please bring [insert list].   The girls will be picked up at 12 noon on 12/21.

My Scout will wear CLOTHES SUITABLE FOR hanging out.  (The below section MUST be filled out each time.) IN CASE OF AN EMERGENCY PLEASE CONTACT:

NAME___________________________________ PHONE______________________ OR_____________________
NAME___________________________________ PHONE______________________ OR_____________________
PHYSICIAN’S NAME___________________________ PHONE__________________________________
My insurance carrier:______________________________ Policy #_____________________________________

PLEASE LIST SPECIAL NEEDS, MEDICATIONS AND COMMENTS BELOW:

  • She is in good physical condition at present and has had no serious illness or operations since her last health examination.
  • I will make sure that she does not attend if she is not feeling well.
  • I give my consent for emergency care to be rendered by another licensed doctor, if unable to reach family doctor.
  • If a private auto is to be used she has my permission to ride.
  • I understand that volunteers and Girl Scouts of Central Texas cannot be responsible for loss of valuables.

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