Girl Scouts of Central Indiana Special Permission Form

Troop _1097 Date Saturday March 20, 2010___ Destination Brownie Badge Event /Sleepover at The Benedict Inn Retreat and Conference Center

1402 E. Southern Ave Beech Grove, IN phone: 788-7581

Arrangements for transportation

Time and place of departure:meet at the Benedict Inn at 7pm

Time and place of pickup: at the Benedict Inn at 8:45 am

Type of transportation each girl will arrange own drop off and pickup__

Leaders accompanying the girls

Name Patricia Johnson_____ Cell#_496-3096_

Troop pays: Girl pays:$10 ________________

Money due to troop leader by (date) †††March 4th

Each girl will work on several badges with a Cadette troop, swimming pool, snack, breakfast in am,

In case of an emergency

Leader will notify the troop emergency contact person who will immediately notify the parents.

Emergency contact person _Jeff Johnson_____ Phone __889-9275_______

Leaderís signature†† Patricia Johnson________________________


Tear off bottom half and return to troop leader by (date)†† _______




My daughter ______________________ has permission to attend the Girl Scout trip to the Benedict Inn

Participate in the described activity, I may be reached at (phone) (________) _______________________________________

If I cannot be reached in the event of an emergency the following person is authorized to act on my

behalf: Name _________________________________ Phone (___) ____________

Relation to participant ______________________________________________________________________Address _____________________________________________City __________________ZIP _____________Additional remarks: Please note if your child has any specific limitations and/or special needs, including medications. Use additional sheet if necessary

Parentís Signature _________________________________Date_________