TROOP781 ACTIVITYPARTICIPATIONAUTHORIZATION

EMERGENCY INFORMATION
(for parents to keep)

Activity: Summer Camp, Cole Canoe Base

Leader in Gharge: Bill Hoefling, Scoutmaster
Departure: Sunday, June 28, 2009, departure times to be determined
Activity Location: Edward N. Cole Canoe Base, 1356 Greenwood
Road, Alger, Ml 48610
Return: Saturday, July 4, 2009, approximately 12-2,to their home
Cole Canoe Base Emergency Number: 1-989-836-2270

Special Instructions: Class A Uniform may be required for Saturday. Bring tents
and camping gear.

TROOP781 ACTIVITYPARTICIPATIONAUTHORIZATION
In consideration of the benefits to be derived and in view of the fact that the Boy
Scouts of America is an educational organization, membership in which is
voluntary, and having full confidence that every precaution will be taken to insure
safety and well being of all participants during the activity noted below, I hereby
acknowledge my awareness and grant my permission for my son, or ward to
participate in the activity.
I further state that my son is in good physical health so far as I know, and that
heishe has permission to engage in all prescribed activities, except as noted by
me. ln the event that I cannot be reached in an emergency, I hereby give
permission to the physician, selected by the adult leader in charge, to hospitalize,
secure proper anesthesia, or to order injection or surgery for my son.

Participant's Name:

Activity: Summer Camp, Cole Canoe Base

Leader in Charge: Bill Hoefling, Scoutmaster
Departure: Sunday, June 28, 2009, departure times to be determined
Activity Location: Edward N. Cole Canoe Base, 1356 Greenwood Road,
Alger, Ml 48610
Return: Saturday, July 4,2009, approximately 12-2, to their home
Deposit: $100, by February 1,2009, balance by March 31, 2009

Fee: $235 to $245 (final price will be determined in January) which covers
registration and meals. (Checks should be made out to Troop 781).

Phone (H) (B)

. Signature Parent/Guardian