Permission Form - Girl Scouts Of North East Ohio
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1Permission Form
Troop/Group ___________________
is planning________________________________________________
Date ____________________ Time ___________________
Location____________________________________
Troop Leader________________________________________
Phone/Cell______________________________
Arrangements:
P/Up Time ___________________
and place of departure _____________________________
Drop Off Time __________________
and place of return _________________________________
Mode of transportation ___________________________________________________________________________
Chaperone __________________________________
Cell/Phone ____________________________
Chaperone __________________________________
Cell/Phone ____________________________
Each girl will need $___________ for expenses to cover ________________________________________________
Other equipment and clothing needed _____________________________________________________________
The following individual will notify the parents or guardians at the number you have listed in the event that
there is a change of schedule or emergency:
Name________________________________________
Cell/Phone____________________________
SAVE TOP HALF FOR ACTIVITY INFORMATION
----------------------------------------------------------------------------------------------------
RETURN BOTTOM PORTION TO TROOP LEADER OR ADULT IN CHARGE OF ACTIVITY
My daughter/ward _______________________________ has my permission to participate in:
________________________________________________________________Date____________________
Please describe any special needs or accommodations that my Girl Scout requires:
_________________________________________________________________________________________
During the activity I may be reached:
Phone # ___________________
Cell # _________________
If I can not be reached in the event of an emergency, please contact:
__________________________________
Relationship to participant: ________________________________
Phone _______________________
__________________________________________
______________________________________
Parent/Guardian Signature
Date
*****Please make sure your Girl Scout’s health form is up to date*****
Revised March 2012
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