Permission Slip:Event [__________________]Date [____/____/____]

Only boys with signed permissions may participate.

My son __________________________________________________ has permission  to participate with  Troop 299 in event [__________________________________________] on dates [_________________________]

He is in good health and may engage in all activities: [  ]yes  [  ]no.  If no, list any exceptions:______________________________________________________________________________________________________________________________________

During this activity, I may be reached at:

Address_____________________________________________________ Phone number______________________

If I cannot be reached in event of an emergency, the following person is authorized to act in my behalf.

Name_______________________________________________________

Relation to participant_________________

Address_____________________________________________________

Phone number______________________

Physician's name and phone number:___________________________________________

Physicians address_________________________________________________________

Additional remarks, allergies or special medical consideration regarding my son ________________________________________________________________________________________________________________________________________________

Date of last Tetanus: ___________________________

In case of an emergency, if none of the above can be contacted, I consent to treatment for my son under the supervision of and as deemed advisable by a physician licensed under the Medicine Practice Act. This provides authority pursuant to Section 25.8 of the California Civil Code.

Parent or guardian's signature_____________________________________ Date:__________________