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.