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:

__Cycling  - San Juan Islands__ Outing

Cost of outing for food /ferry is $75.00 due on July 31

From (Departure Date)__August 12, 2007__To (Return Date)__August 18, 2007__

I do hereby waive, release, absolve, indemnify, and agree to hold harmless any person connected with Chapel Hill Presbyterian Church, Troop212, 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.

 _____________________________________________________________________________

_____________________________________________________________________________

Emergency contact if you are unavailable

Name_____________________________________________

Phone ____________________________________________

Signed_____________________________________Phone_______________Date___________

_____________________________________________________________________________
detach here

Retain this portion until the outing is complete

Outing Name __Cycling – San Juan Islands__

Meet at QM Container____6:30 am  Sunday August 12, 2007___________________

Return to QM Container __ 3:00  pm Saturday August 18, 2007__________________

Adult in charge __Mr. Tibke______________ Phone__253-265-6193______

Emergency contact:  Larry Ollice            Phone    253-514-8272

Scouts: Wear your scout shirt during travel.  Dress for a long term outing. You need a daypack and ten essentials.  Note: This is a long term cycling outing with rides from 10 to 25 miles in length with one 50 mile ride with the intent of obtaining the cycling merit badge.  There will be several training rides scheduled prior to the trip.