BSA TROOP 58 Permission Slip

Troop Outing to Maine Rock Gym

When:   Monday, March 27, 2006 6:00 PM
Where:  Maine Rock Gym, Marginal Way, Portland
Meet:    Maine Rock Gym, Marginal Way, Portland
Payment: $16.00 per person
Permission Slip and Payment Due: At the event Parents must also fill out Maine Rock Gym's own permission slip to authorize participation.


Return this portion with payment No Slip, No Trip

BSA TROOP 58 Permission Slip

When:   Monday, March 27, 2006 6:00 PM
Where:  Maine Rock Gym, Marginal Way, Portland
Meet:    Maine Rock Gym, Marginal Way, Portland
Payment: $16.00 per person
Permission Slip and Payment Due: At the event Parents must also fill out Maine Rock Gym's own permission slip to authorize participation.

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.


Emergency phone: __________________________________

Signed:______________________________________________ Date:__________________
(parent or guardian)

Adult Name (print):________________________________________



Scouts are responsible for own transportation.