BSA TROOP 58 Permission Slip

Troop Outing to Lonesome Lake

When:   Saturday and Sunday, November 5 & 6, 2005
Where:  Lonesome Lake, Franconia Notch, New Hampshire
Meet:    Wescustogo Hall, North Yarmouth, Departure Time TBD
Payment: $40.00 total includes housing, food and transportation. Make checks out to BSA Troop 58
Permission Slip and Payment Due: Monday, October 24, 2005


Return this portion with payment No Slip, No Trip

BSA TROOP 58 Permission Slip

What:    Troop Outing to Lonesome Lake
When:   November 5 & 6, 2005
Where:   Lonesome Lake, Franconia Notch, New Hampshire
Payment: $40.00. Make checks out to BSA Troop 58
Permission Slip and Payment Due: Monday, October 24, 2005

Scout Name
(s):_________________________________________________________
has permission to participate in all aspects of the above Boy Scout activity with the leaders and parents of BSA Troop 58.
I understand the risks and dangers involved, and will not hold the leaders nor Troop 58 liable for any accident or injury which may occur during this activity. In the event of illness or accident in the course of this activity, I request that measures be instituted without delay as the judgment of Troop leaders or medical personnel dictates.

Your signature below is a commitment. If you sign up for a trip, and then find that you cannot go, remember that plans have been made to accommodate you, and payments have been made for reservations and supplies. We honor your word. Please honor your commitment by paying for your share of these expenses whether you go or not.

Emergency phone: __________________________________

Signed:______________________________________________ Date:__________________
(parent or guardian)

Adult Name (print):________________________________________


_____ Yes, I will go, drive, and help. # of Seatbelts:__________________

_____ No, I'm not going, but I can drive. # of Seatbelts: __________________

Year/Make/Model: ____________________

Me. Lic #: ___________________________