St. Vincent Girl Scouts

Appreciation Day Permission Slip

Contact information:
My daughter (info filled below) has my permission to participate in the St. Vincent Girl Scout Appreciation Day to be held at the St. Vincent Scout Lodge on Auburn Road.
Scout Name/s:
Troop Number: (Select All That Apply)		Troop 3 Troop 60 Troop 126 Troop 200 Troop 302 Troop 412 Troop 525 Troop 650 Troop 770
Email address:		Troop 963
Cell number:
Telephone number:
Event Options:
I want to ride Bus		Yes No
I know the bus ride will cost me $5
I would like to bring my family members		Yes No
I know I have to wait until May 26th to find out if there's enough room for my family to swim.
Excluding me, # of people coming
If my family comes, I know they might have to follow the bus.
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: