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Zip Line Permission Slip - Troop677.org


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									                                         BSA Troop 677 Activity Permission Form
                                               *** Parent or Legal Guardian Signature Required ***

 Zipline/Onondaga Cave State Park – November 8-10, 2013
 Due Date: October 22, 2013 Troop Meeting                                                          Refund Date: October 29, 2013

Please Print Information

My son(s) / ward(s) ______________________________________________________________________ has permission to
attend the Zipline/Onondaga Cave State Park Outing on the dates of November 8-10, 2013, at Onondaga State Park.
 He is in good physical condition and I will make sure that he does not attend if he is not feeling well.
 He may receive emergency treatment at my expense.
 Signature of Parent or Legal Guardian _______________________________________________
 Phone # (_____) _____-_________              Date ______/_____/______

Emergency Information
           Name                               Phone Number                  Insurance Company Name                       Policy Number

Comments concerning my son(s)/ward(s) health, medications, or special needs:

Adults are always welcome to attend Scouting events. I am able to attend and would like to assist in the activities or other responsibilities.
Adult(s) Attending: ______________________________________________________________________________________
Transportation: My son(s)/ward(s) have a ride to/from the outing with ____________________. If driving, please provide year/make/model
of vehicle _______________________, number of seatbelts _________, and insurance carrier name/coverage (i.e. State Farm,
100/300/100) _________________________________________________

Activity Fee: $50:00 per Scout               *Please make checks payable to “BSA Troop 677”
              $25.00 per Adult
Due Date:     October 22, 2013                                                             Refund Date: October 29, 2013
                       The permission slip and check may be given to Quinn Graessle at troop meetings or mailed to:
                                                        Quinn Graessle
                                                       232 Old Ballwin Rd.
                                                       Ballwin, MO 63021
                                             (636) 527-1921 (H) (636) 675-6614 (Cell)
                                                          Detach and retain for your information
                                                   Zipline/Onondaga Cave State Park Outing
OBJECTIVE:          A great experience where you can zipline, hang out on a river bank and camp out.
DATE:               Nov. 8-10, 2013
REFUND DATE:        Oct. 29, 2013
LOCATION:           Onondaga Cave State Park, Leasburg, MO – Blue Springs Ranch in Bourbon, MO for Zipline
DEPART:             Arrive Friday @ 5:45pm at Living Word Church parking lot. Departure @ 6:00pm sharp; Drive time approx. 75 minutes. Bring money for
                    dinner on the way.
RETURN:             Sunday, 10:00am @ Living Word Church parking lot.
MAP:                Maps will be provided at departure
TRANSPORTATION:     Coordinated by patrols
COST/FEES:          $50.00 per Scout, $25.00 per Adult which includes: Camping fees for 2 nights; Saturday breakfast, lunch, dinner, Sunday breakfast and
                    two Cracker Barrels (Friday and Saturday) and the Blue Springs Ranch Zipline.
MEALS:               By patrol method
ITEMS TO BRING:     A great attitude along with:
                    Class A Uniform (wear Friday and Sunday while traveling)              Pocketknife (if you have a Tot’n Chip) & Toasted Chit
                    $$ for Friday dinner on way to Leasburg                               Clothes for variable weather
                    Boy Scout Handbook, Notebook (or paper) and Pencil (or pen)           Rain Gear
                    Sleeping bag and pillow                                               Stool for campsite
                    Compass                                                               Hiking Boots
                    Flashlight                                                            Toothbrush, Toothpaste, Soap, Hand Towel
                    Water bottle, Mess Kit and Cup                                        Sun Screen and Non-Aerosol Insect Repellent

LEAVE HOME:         Electronic games, Portable CD players, TVs, Radios

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