PERMISSION SLIP Unit: Pack 4996, Mullan Trail District

As the parent or legal guardian of , I hereby

give my permission for him to participate in an outing with Pack 4996.

Date:

Location:

Time/Place of Departure:

Time/Place of Return:

I give permission to the leaders of the above unit to render First Aid,

should the need arise. In the event of an emergency, I also give

permission to the physician, selected by the adult leader in charge, to

hospitalize, secure proper anesthesia, order injection, or secure other

medical treatment, as needed. I further agree to hold the above named

unit and its leaders blameless for any accidents that might occur during

this outing except for clear acts of negligence or non-adherence to BSA

policies and guidelines.

In case of emergency, I can be reached by phone at ________________

or ________________. If I cannot be reached, please contact

____________________________________ at ____________________________.

Signed: _________________________________________ Date: ___________

(Parent or Guardian)

PERMISSION SLIP Unit: Pack 4996, Mullan Trail District

As the parent or legal guardian of , I hereby

give my permission for him to participate in an outing with Pack 4996.

Date:

Location:

Time/Place of Departure:

Time/Place of Return:

I give permission to the leaders of the above unit to render First Aid,

should the need arise. In the event of an emergency, I also give

permission to the physician, selected by the adult leader in charge, to

hospitalize, secure proper anesthesia, order injection, or secure other

medical treatment, as needed. I further agree to hold the above named

unit and its leaders blameless for any accidents that might occur during

this outing except for clear acts of negligence or non-adherence to BSA

policies and guidelines.

In case of emergency, I can be reached by phone at ________________

or ________________. If I cannot be reached, please contact

____________________________________ at ____________________________.

Signed: _________________________________________ Date: ___________

(Parent or Guardian)