TROOP 857 PERMISSION SLIP
Event _______________________________________ Dates ________________________
I authorize my son, ________________________________________, to attend the
Scout outing described above. I understand that there will be a competent
adult leader in charge. In the event of a medical emergency, if I cannot be
contacted, I give permission to the adult leader in charge to authorize any
medical treatment deemed necessary by the attending physician. This includes
hospitalization, anesthesia, and surgery. As a driver, I certify that I carry
at least $50,000/$100,000 public liability, $50,000 property damage insurance.
Parent will: Drive for this outing? (YES/NO)
Make, model and year of vehicle ______________________________________________
Number of passengers -__________ Vehicle License #_______________________
Driver's License # ______________________
Health Care Insurance Co. ____________________________________________________
Hospitalization Insurance_____________________________________________________
Parent signature____________________________________ Date____________________
Phone number where parent can be reached during this event____________________