Boy Scout Troop 212
Chapel Hill Presbyterian Church
Troop Outing Permission Slip

I, the parent or guardian of _____________________________________________________
hereby give my consent and permission to participate in the:

_______________________________________Outing

From (Departure Date)_______________To (Return Date)______________

I do hereby waive, release, absolve, indemnify, and agree to hold harmless any person connected
 with Chapel Hill Presbyterian Church, Troop212, and the scouting program and persons
 transporting my child

I am willing to provide transportation  ________  Number of people including driver _______

My son will be arriving late / leaving early ________  If yes, please provide details below

_____________________________________________________________________________

My son has a medical condition (i.e. allergies, etc.) and / or is taking medication __________
If yes, please provide details below.  Please contact the adult in charge with written Instructions.

 _____________________________________________________________________________

_____________________________________________________________________________

Emergancy contact if you are unavailable

Name_____________________________________________

Phone ____________________________________________

Signed_____________________________________Phone_______________Date___________

_____________________________________________________________________________
detach here

Retain this portion until the outing is complete

Outing Name______________________________________

Meet at QM Container____________________________________________

Return to QM Container ___________________________________________

Adult in charge__________________________ Phone___________________