Fillable Blanket Permission Form printable pdf download

Parent/Guardian Information

Blanket Permission Form

Permission for Girl Scout Activities

Girl Scout name ___________________________________________________________________________

Parent/Guardian’s name _____________________________________________________________________

In case of emergency notify:

Full Name __________________________________ Full Name ___________________________________

Home

__________________________________ Home

___________________________________

Cell

__________________________________ Cell

___________________________________

Relationship _________________________________

(Girl’s name) ______________________ has my permission to be a Girl Scout for the 20____-20____ year and join

troop #________ in regular meeting activities. I understand that for any activity which takes place at a different time

and/or place than a regular meeting, I will receive a SPECIAL ACTIVITY PERMISSION FORM to fill out and return to the

troop leader permitting my girl to participate.

I ☐do ☐do not give my permission for my daughter to be photographed or to have photos used for the purpose of

promoting Girl Scouting.

Persons permitted to pick up my Girl Scout from activities:

__________________________________________ Phone __________________________

2. __________________________________________ Phone __________________________

3. __________________________________________ Phone __________________________

4. __________________________________________ Phone __________________________

Permission for Emergency Treatment

In the event (girl’s name) ______________________ becomes ill or sustains an injury while in the care of or under

the supervision of the Girl Scouts of Southern Nevada or any of its officers or leaders, I authorize first aid to be

administered. If it should become necessary to seek professional medical treatment, I give permission for a licensed

medical professional to administer any medical and/or surgical treatment he/she deems necessary, including

hospitalization. I understand that every effort will be made to contact me, or if not possible, one of the parties listed

under Emergency Contact. I accept full financial responsibility for all expenses incurred that are not covered by Girl

Scout Activity Insurance.

Parent/Guardian Signature ______________________________________________ Date _________________

Phone (day) ___________________________________ (evening) ___________________________________

I do not desire this authorization and understand that in so choosing I release and relieve from all liability whatsoever

Girl Scouts of Southern Nevada, its officers and leaders. In case of emergency, please follow this procedure:

________________________________________________________________________________________

Parent/Guardian Signature ______________________________________________ Date _________________

Blanket Permission Form