I HEREBY GIVE MY PERMISSION for my son/daughter,___________________________, participate/attend:
Activity: _______________________________

Date(s):_______________________________

I realize that every precaution will be taken for the safety of my child. I agree not to hold Venturing Crew 168 or its adult chaperones, paid or voluntary, responsible in any way for any accident which might occur. I further give my permission to the chaperones to obtain MEDICAL TREATMENT for my child should that be seen as necessary by them, medical personnel or other competent authority.

(Signed,) ____________________________________________________________

Date: ____________________

Telephone number where you can be reached during the above times indicated:  REQUIRED

(_____)-______-___________  [  ] Cell [  ] Home

Telephone number where another adult (Grandparent, Aunt, Uncle, etc.) can be reached during the above times indicated:  REQUIRED

(_____)-______-___________    __________________ Name  ____________ Relation

This is a generic permission slip, please determine if there are any costs to this particular activity and when and where you need to pick your child up from this activity before leaving your child with Crew 168.

 

Cost:  _____________________

 

DROP OFF TIME: _________________

PICK UP TIME:  __________________

 

PICK UP / DROP OFF LOCATION: ____________________

 

Emergency Leadership Cell Phone Numbers:

Mr. Tassinari (413)219.2513.

Mr./Mrs. Corbett (508)615.0216./(774)253.1626.

Mr. Buck: (508)304-4123.