• Health and Permission Form

    Completed by parent/guardian
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  • HEALTH HISTORY

    Check those that apply

  • PARENT/GUARDIAN AUTHORIZATION: This health history is complete and accurate, and the person herein described has my permission to engage in all prescribed activities, except as noted by me. In the event I cannot be reached in an EMERGENCY, I hereby give permission to the physician named above, or, if not available, to the physician selected by the adult in charge, to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child as named above.

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  • Parent or Guardian Permission for Participation in Girl Scout Activities

  • HOLD HARMLESS AGREEMENT

    I hereby release and hold harmless Girl Scouts - Dakota Horizons from any and all claims or liability arising from, out of or associated with my child's participation in the activity(s) listed on this form. My signature should be placed next to each event on this form evidencing my release of the Council, its agents and employees as to that specific activity.

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  • My daughter has permission to participate in the Girl Scout activity listed below. I will make sure she does not attend if she is not feeling well.

  • Should be Empty: