St. Vincent Girl Scouts

Mother/Daughter Tea Party Permission Slip

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DEADLINE FOR EVENT SIGN-UP:  Tuesday, February 10

Contact information:
My daughter (info filled below) has my permission to participate in the St. Vincent Girl Scout Mother/Daughter Tea Party to be held at the St. Vincent Scout Lodge on Auburn Road.
Scout Name/s:
Tea Party Companion Name/s:
Troop Number:
(Select All That Apply)
Troop 3 - 7th & 8th Grade
Troop 60 - 2nd Grade
Troop 126 - 1st Grade
Troop 200 - 3rd Grade
Troop 302 - 4th Grade
Troop 412 - High School
Troop 525 - 6th Grade
Troop 650 - 5th Grade
Troop 770 - KGarten
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: