Parent’s Permission for Special Activities

(Every Scout taking part in any Cub Scout sponsored activity other than at a regularly scheduled meeting of his Pack and/or requiring transportation, must present a permission slip signed by the parent/guardian for such activity.)

Pack 51 of the San Gabriel Valley Council of California is planning ___________________________ activity on ____/____/200___ though ____/____/200___ at ________________________________.

Leader in charge: _________________________________________________________________

Secondary Leader: ________________________________________________________________

We will leave from: _____________________________________ at __________________ PM

Return to: ____________________________________________ at __________________ PM

Cost per Scout: $ __________________ for __________________________________________

Bring: _________________________________________________________________________

q Additional items listed on back or attached.

In case of emergency, leader will call: ________________________________________________ who will immediately get in touch with parents.

(When completed, detach and return bottom portion to the Unit Leader.)

My son, ___________________________________________________ has permission to attend the __________________________________________________________ on / / 200 . with Pack 51. I will make sure that he does not attend if he is not felling well.

Remarks: _______________________________________________________________________

Alternate person to contact in emergency:

___________________________________________________ phone #: _____________________

To Unit Leader:

My son, ____________________________________________ is on special medication:

_________________________________________________ for ____________________________

(List Special medication conditions and/or restrictions, e.g. asthma, allergies, strenuous exercise, etc.)

________________________________________________________________________________________

(If none, please write “NONE”)

Signature _________________________________________________ Date: _________________

(Parent or Guardian)

Day time Phone #: ______________________ Evening/Night time Phone #: ___________________