TROOP 781 ACTIVITYPARTICIPATION AUTHORIZATION

EMERGENCY INFORMATION
(for parents to keep)
Activity: WinterHike Saturday, Jan 10,2009
Leader in Charge: Bill Hoetling,
Time: 8:30pm to 12:30 pm

Meet at OLGC School at 8:30 AM

Activity Location:Campiffitr Great Sauk Trail Council

Gregory MI48137

Emergency Number: 1.734.634.7921

Special Instructions: Dress warm.

TROOP 7ET ACTIVITYPARTICIPATIONAUTHORIZATION

In consideration of the benefits to be derived and in view of the fact that the Boy Scouts
of America is an educational organization, membership in which is voluntary, and having
full confidence that every precaution will be taken to insure safety and well being of all
participants during the activity noted below, I hereby acknowledge my awareness and
gfant my permission for my son, daughter, or ward to participate in the activity.
I further state that my son or daughter is in good physical health so far as I know, and that
he/she has permission to engage in all prescribed activities, except as noted by me. In the
event that I cannot be reached in an emergency, I hereby give permission to the
physician, selected by the adult leader in charge, to hospitalize, secure proper anesthesia,
or to order injection or surgery for my son or daughter.

Participant's Name:

Activity: Winter Hike Saturday, Jan 10,20A9

Leader in Charge: Bill Hoefling,
Time: 8:30AM to 12:30 pm
Activity Location: Carnp Munhacke Great Sauk Trail Council
20120 Bartell Rd
Gregory MI48l37

Phone (H) _ (C)

S i gnature Parent/Guardi an
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