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:

Leadership Outing: Camp Delezeene – Fee $10.00

From Friday November 10th To Sunday November 12th

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___________

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detach here

Retain this portion until the outing is complete

Leadership Outing: Camp Delezenne – Fee $10.00

Meet at QM Container Friday November 10th @ 5:00 PM – Leave @5:30PM bring sack dinner

Return to QM Container Sunday November 12th @1:00PM – Bring Money for lunch

Adult in charge: Cliff Uehlin    Phone: 265-8345   
Emergency Contact: Scott Eason    Phone: cell - 208-9955  home - 549-4181
Scout in charge:  Ryan Eason    Phone: 549-4181
Bring winter gear and prepare for getting wet.  Cooking by patrol.