RETURN: Pick up at 11AM

DESTINATION: Inglemoor Rehabilitation and Care Center

311 South Livingston Avenue (next to YMCA)

BRING: skits, instruments to perform

COST PER SCOUT: nothing

Uniformed required Question contact Gail or Ian Stocks 973-495-2297 or 2362

PERMISSION SLIPS AND PAYMENT MUST BE SUBMITTED TO Mr Waxman  BY THURSDAY, March 22, 2012

PERMISSION SLIP

1)　　　　 I hereby give my son__________________________________________________ permission to

(First and Last Name)

participate in the :Morning Entertainment at Inglemoor Rehabilitation and Care Center Saturday April 21 2012　

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:　 ________________________________________

Adults must bring and pick up their own scout

PARENT’S OR LEGAL GUARDIAN’S SIGNATURE: