My son, ________________, has permission to attend the camp out to _________________, with Troop 109 on ____ ____. I will make sure that he does not attend if he attend if he is not feeling well.

Remarks:_____________________________________________________

ALTERNATE PERSON to contact in an emergency:

_______________________ Phone_______________________

TO UNIT LEADER:

My son, _________________, is on special medication:

______________________________ for _______________________

Special medical conditions and/or restrictions, such as asthma, allergies, strenuous exercise,etc:

_____________________________________________________________________________

_____________________________________________________________________________

(If none, please write "NONE".)

Signature _____________________ Date _____________________

Phone No. (Days)____________________________ (Eves)__________________