St. Vincent Girl Scouts

Lenten Retreat Permission Slip

Contact information:
My daughter (names listed below) has my permission to particiapte in the St. Vincent Lenten Retreat Event that is going 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:
Cell number: 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:
Additional Information:  -  CHECK ALL THAT APPLY -
	I will attend the retreat & mass (no dinner, dance or overnight) (1:00-6:00pm) Cost $5.00 (only option for 3rd grade and below)
	I will attend the retreat, mass, dinner & dance (1:00-10:30pm) Cost $8.00
	I will attend the retreat, mass, dinner, dance & overnight (1:00pm-8:00am) Cost $8.00
I would like to help in the following fashion.  I understand that if I volunteer, there is no charge for the retreat and dinner.  CHECK ALL THAT APPLY
Volunteer Name/s:
Volunteer Email:
Volunteer Phone:
	Set-Up (8:00-10:00am) Includes: Setting up tables, chairs, food prep, craft placement
	Check-in/Registration (12:15-1:15am) Includes: distribute name tags, patches, craft bags; direct where to put service project donation
	Station Supervisor (12:30-4:30pm) Includes: Staying @ station while children rotate through stations
	Dinner/Dance (6-10:30pm) Includes: Hand-out Pizza, pour pop, stay and chaparone dance
	Overnight Helper (10:30-8:00am) Includes: Staying overnight and help pass out breakfast and do final clean-up.