Girl Scouts Of Ne Kansas & Nw Missouri Parents/guardians Information Form For Day Or Overnight Trip(S) Form

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Girl Scouts of NE Kansas & NW Missouri
Girl Scouts of NE Kansas & NW Missouri
Parents/Guardians Information Form
Parents/Guardians Information Form
For Day or Overnight Trip(s)
For Day or Overnight Trip(s)
To be completed by the leader:
To be completed by parent/guardian and returned to leader:
Troop # ______________ is planning a trip to (Activity) _______________________
Trip date: _____________________ Activity: ______________________________
From (date/times) __________________________ to ________________________
Return this half of the form to the leader no later than (date) _________________
Location _____________________________________________________________
Daughter’s Name ______________________________________________________
Phone # _____________________________________________________________
Leader/Adult names in charge and cell phone numbers accompanying the girls will
Notice that my Girl Scout will NOT participate in the trip listed
be: __________________________________________________________________
 No, My Girl Scout does NOT have my permission to participate in this trip.
____________________________________________________________________
Parent/Guardian signature______________________________ Date ____________
_____________________________________________________________________
Permission for participation (complete and sign where indicated)
___________________________________________________________________
 YES! My Girl Scout has my permission to participate in the trip indicated above.
Transportation Method: ________________________________________________
 YES! My Girl Scout has my permission to participate in the trip indicated above
We will meet at/depart from: ___________________________ Time: ___________
with the following limitations and/or reasonable accommodations:
(Please
We will return to: _____________________________________ Time: ___________
describe)
Activities in which girls will be involved (state clearly if high risk activities are
During the activity, I (we) may be reached by (Phone):________________________
involved):
(Address)_____________________________________________________________
____________________________________________________________________
Mother/Guardian cell #: _________________ Father/Guardian cell#:____________
____________________________________________________________________
Family Physician: _______________________ Phone#:________________________
____________________________________________________________________
If I (we) cannot be reached in the event of an emergency, the following person is
authorized to act in my (our) behalf:
Each girl will need:
Name: _______________________________________________________________
Expenses/Money: ______________________________________________________
Address: _____________________________________________________________
Phone#:___________________________ Relationship:_______________________
Clothing/Equipment: ___________________________________________________
My daughter is in good physical condition and has not had any serious illness or
In case of emergency or delay, the leader will notify the following adult. This person
operation since her last health examination. If my child should have a serious illness,
will notify parents/guardians in the event of an emergency:
operation or be exposed to a contagious disease between the date the permission
Name: _______________________________________________________________
form is signed and the activity, I will notify the troop leader.
Address: _____________________________________________________________
Phone: ______________________________________________________________
I understand that every effort will be made to contact me, but in the event I cannot
*Parents/Guardians: BE SURE YOU HAVE DETACHED THIS HALF OF THE ACTIVITY
be reached, I give my permission to the physician selected by the troop leader to
PERMISSION FORM. IT IS FOR YOUR INFORMATION.
hospitalize and/or secure proper treatment for my child in an emergency.
______________________________________________
__________________
Parent/Guardian signature
Date

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