St. Vincent Girl Scouts

Camp Logan Open House

Contact information:
My daughter (info filled below) has my permission to participate in the St. Vincent Girl Scout trip to the Camp Logan Resident Camp Open House in Syracuse IN.
Scout Name/s:
Troop Number: (Select All That Apply)		Troop 3 Troop 60 Troop 200 Troop 302 Troop 412 Troop 525 Troop 650
Email address:
Telephone number:
Physical Condition:
Allergies:	Yes No
Medicine Sent:	Yes No
Physical Restrictions:	Yes No
Emergency Contact Information:
In the event that I can not be reached at the above information, the following person is authorized to act on my behalf:
Emergency Name:
Emergency Phone:
Physician Name:
Physician Phone:
Preferred Hospital: