Permission Form
A parent or guardian is required to fill this form out for every participant.
Troop Number
*
Troop Leader Email
*
example@example.com
Girl Scout Name
*
First Name
Last Name
Girl Scout Grade Level
*
Please Select
6
7
8
9
10
11
12
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contacts
*
Please elaborate on any health conditions or medication information which may be valuable to the persons in charge of the encampment.
I am the parent/guardian of the above named participant and the participant has my permission to attend the Piper Valley Encampment at Camp Lakamaga September 20 - 22, 2024. In my opinion, the participant is physically and emotionally able to participate in encampment activities, subject to restrictions noted above on this form. In the event of an emergency and I cannot be reached/consulted, I hereby grant permission to the physician by the event director to secure proper treatment for my child.*
*
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