Girl Scouts of Central Indiana Special Permission Form

Troop _1097 Date Saturday February 11, 2010___ Destination Cold Stone Creamery 789 N US 31, Greenwood ( by the Mall off Fry) phone: 882-2501

Arrangements for transportation

Time and place of departure Leave Pleasant Grove parking lot 3:45

Time and place of pickup: Cold Stone Creamery at 5:30 pm

Type of transportation __Car, van______________________________________

Leaders accompanying the girls

Name Patricia Johnson_____ Cell#_496-3096_

Troop pays: $3 Girl pays :O Optional spending money _________________

Money due to troop leader by (date) ___________________________________________________________

Each girl will get to get a tour of the store, how their ice cream is made, and sample the ice cream 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_______

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 Cold Stone Creamery

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_________