St. Vincent Girl Scouts

Mother/Daughter Tea Party Permission Slip

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: