Cindy Hoefling

TROOP 781

ACTIVITY PARTICIPATION AUTHORIZATION EMERGENCY INFORMATION (for parents to keep)

Activity: Rock and Roll Hall of fame Activity Date - March 6, 7 & 8, 2009 Leader in Charge: Bill/Cindy Hoefling, Time: meet at OLGC School at 5:15 pm on March 6 Return around 1:30pm on March 8 2009 Activity Location: Rock and Roll Hall of Fame 751 Erieside Ave Cleveland OH Cost of trip - $40 + food money Emergency Number: 1.734.634.6062 Special Instructions: Cost above includes tickets to the Rock and Roll Hall of fame for scouts which are $11.35 each inc Patch. Scouts will need to bring money for lunch and dinner as we are eating out ---------------------------------------------------------------------------------------------(Cut here) TROOP 781

ACTIVITY PARTICIPATION AUTHORIZATION

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, daughter, or ward to participate in the activity. I further state that my son or daughter is in good physical health so far as I know, and that he/she has permission to engage in all prescribed activities, except as noted by me. In 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 or daughter. Activity: Rock and Roll Hall of fame Activity Date - March 6, 7 & 8, 2009 Leader in Charge: Bill/Cindy Hoefling, Time: meet at OLGC School at 5:15 pm on March 6 Return at 1:30pm on March 8 2009 Activity Location: Rock and Roll Hall of Fame 751 Erieside Ave Cleveland OH Emergency Number: 1.734.634.6062 Participant's Name:

. Phone (H)

Signature Parent/Guardian

(C)

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