I can drive for this trip: �Yes �No. If yes, I can take (#) _____ of boys with me, including my own son.
Return this permission slip to the leader by __________________ with $__________.

Only boys with signed permission slips turned in prior to date of event may participate.

My son _____________________________________________has permission to participate in Troop activity ___________________________ on (dates) _____________________.

He is in good health and may engage in all activities: �Yes �No.

If no, list any exceptions: ______________________________________________________

During the activity, I may be reached at:

If I cannot be reached in the event of an emergency, the following person is authorized to act in my behalf.

Name ______________________________ Relationship to participant_________________

Address_______________________________ Phone_____________________

Physician’s name and phone __________________________________________________

Additional remarks, allergies or special medical consideration regarding my son ________________________________

 ________________________________________________________________________

In case of emergency, if none of the above can be contacted:
I consent to treatment for my son under the supervision of and as deemed advisable by a physician licensed under the Medicine Practice Act. This provides authority pursuant to Section 25.8 of the California Civil Code.

Parent or Guardian Signature _________________________________________

Date ____________________