Girl Scouts of Central Indiana Special Permission Form

Troop _1097 Date Saturday February 13, 2010___ Destination North Central High School, 1801 East 86th Street phone: 253-9582

 Arrangements for transportation

Time and place of departure Leave Pleasant Grove parking lot 10am

Time and place of pickup: McDonald’s State Road 135 1pm

Type of transportation __Car, van______________________________________

Leaders accompanying the girls

Name Patricia Johnson_____ Cell#_496-3096_

Troop pays: all Girl pays :O Optional spending money _________________

Money due to troop leader by (date) ___________________________________________________________

Each girl will get to earn the Sound of Music Try-it, enjoy the concert and instrument petting zoo, lunch at McDonalds after.

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_______

Leader’s 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 North Central Tootsie Pops

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

 Parent’s Signature _________________________________Date_________