EVENT:
Klondike Derby ACTIVITY: Skills
competition
DEPART: Fri, Jan 28, 2011 at 5:00 PM
RETURN: Sun., Jan. 30, 2011 at 12:00PM
DESTINATION: Camp Glen Gray Mahway, NJ
BRING: bag Diner for Friday hat, coat, gloves, hiking boots, raingear,
COST PER SCOUT: To Be Announced
PERMISSION SLIP REQUIRED FOR EACH YOUTH PARTICIPATING REGARDLESS IF PARENT IS ATTENDING. PARENTS ARE ALWAYS WELCOME.
PERMISSION SLIPS AND PAYMENT MUST BE SUBMITTED TO MRS. BARNARD OR MRS. PISCIOTTI BY THURSDAY, Jan. 6, 2011
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Scoutmaster: Dick Barnard 973-597-0355
Committee Chairman: Bill Brady 973-740-1571
Cell Phone 973-879-8498
PERMISSION SLIP
- I hereby give my son__________________________________________________ permission to participate in the Jan.28-Jan 30, 2011 campout.
(First and Last Name)
2. Permission is granted to Troop 12 leaders to authorize any emergency medical treatment required.
3. Parent contact in the event of an emergency:
Phone Number: ___________________________
Alternate Phone Number: ______________________________
4. An adult attending is expected to help provide transportation for Scouts and/or equipment. Please notify the Scoutmaster if you cannot provide transportation.
ADULT WILL BE ATTENDING:
Yes 
No
Name of adult attending: ________________________________________
5. Adults not attending may still be asked to help with transportation.
ADULT NOT ATTENDING BUT CAN PROVIDE TRANSPORTATION:
Going 
Returning 
6. My son will not depart / return with the rest of the troop:
Departing: _______________________ with __________________________________
(Date / Time) (Person Providing Transportation)
Returning: _______________________ with __________________________________
(Date / Time) (Person Providing Transportation)
PARENT’S OR LEGAL GUARDIAN’S SIGNATURE:____________________________________________________________________