BOY SCOUTS OF AMERICA TROOP 22

Permission Slip

Activity Planned: Chas’s Eagle Scout Service Project!

Date(s): January 18 & 19, 2003 Destination: William Tell Aggeler HS

21050 Plummer Street,

Chatsworth

Departure From: Your house (please provide your own transportation, and thank you)

Time: Any time you can give between 9 a.m. & 4 p.m. on Saturday,

from 9 a.m. til we are done on Sunday

Contact Person for Questions Regarding Outing: Chas (818) 998-5536

Emergency Contact Number: (626) 883-9777

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Scout Trip Permission Form

(To Be Completed by Parent or Guardian)

Youth’s Name:

_________________________________________________________________________

Has my permission to attend Chas’ Eagle Scout Service Project at William Tell Aggeler High School

Saturday and/or Sunday, January 18/19, 2003. In the event emergency medical treatment is required, I hereby give permission for any adult from Troop 22 to authorize such treatment.

______________________________________ ________________________________

Signature of Parent or Guardian Telephone Number

______________________________________________ ______________________________________

Telephone number where parent or guardian can be Emergency contact (if the parent or guardian

reached during the outing (if different from above) is not available) & phone