E.O.C.S. 2006 Spring Camporee
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- April 28-30, 2006
Page 22
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 your name above
have noted the above cautions, restrictions, or exclusions.
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