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
