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The Eastern Orthodox Committee on Scouting - Camporee 2003 booklet (Page 20)

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The Eastern Orthodox Committee on Scouting - Camporee 2003 booklet
EASTERN ORTHODOX COMMITTEE ON SCOUTING
PERMISSION SLIP/ MEDICAL RELEASE FORM
This form must be completely and properly filled out in order for any scout to
participate. No exceptions or substitutions for this form will be accepted.

I,_______________________ , parent/guardian of __________________________
Parent/ guardian -- print name here print name of scout attending here

give permission to my child to attend the ___________trip to __________________

on _____________________________

We will leave from __________________________on___________at____________
Place
date
time

We will return to __________________________on___________at____________
Place
date
time

You are responsible to meet your son or daughter when we return

I understand that from assembly, until dismissal, my child will be under the care and
supervision of the adult leader:____________________________

I give my permission for full participation in the EOCS programs, subject to
limitations noted herein. In the event of illness or accident in the course of such
activity, I request that measures be instituted without delay as judgment of medical
personnel dictates.

______________________ ____/____/____
Parent/guardian sign here
date

Telephone # day: ( )____________________
Area code
Number
Night # : ( )____________________
Area code
Number

Check one box:
[ ] There are no cautions, restrictions, or exclusions
[ ] The following cautions, restrictions or exclusions do apply, and should be noted
by the adult leader.
___________________________________________________________________

___________________________________________________________________


I,_________________________ , an authorized adult leader with ______________
leader - print name here

have noted the above cautions, restrictions, or exclusions.


______________________
Leader's signature

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