Cumberland North Yarmouth

Permission Slip, Zealand Falls (AMC Hut) Trip

When: Saturday, December 13 - Sunday, December 14, 2003

Where: Hike up to Zealand Falls AMC hut.

Cost: Camping: $20.00 per person. We have spaces for 24 people.
Food: $ 8.00 per person, includes dinner on Saturday, breakfast and lunch on Sunday.

Gas: $ 5.00 unless traveling with own family. Adult cost will not include gas fee.

Return this portion with payment No Slip, No Trip
Zealand Falls AMC Hut
Saturday, December 13 - Sunday, December 14, 2003

____________________________ (scout) has my permission to participate in all aspects of the above listed outing, as well as other related items that may arise on the agenda, with Troop 58 BSA. I realize there may be activities that can result in injuries. I give my permission to the representatives of Troop 58 to render any and all medical assistance they deem necessary. (This serves as permission to render medical treatment.)

Signed: _____________________________ Phone: __________________

Adult Participation: I will attend and drive __________________________

I will attend but will not drive ____________________________________

Driver's License number: ________________________________________

Vehicle Type and Year: _________________________________________

Vehicle Plate Number: _________________ Seatbelts: ________________