PERMISSION SLIP
                    
               Cub Scout Pack 165  Wellington, Florida



As the parent or legal guardian of ________________________________, I hereby 
                                   (participating scout or sibling)

give my permission for him/her to participate in an outing with Cub Scout Pack 165.

Date:____________________ 

Location:__________________________________________________________________________  

Time/Place of Departure:___________________________________________________________

Time/Place of Return:______________________________________________________________

I give permission to the leaders of the above unit to render First Aid, 
should the need arise.  In the event of an emergency, I also give 
permission to the physician, selected by the adult leader in charge, to 
hospitalize, secure proper anesthesia, order injection, or secure other  
medical treatment, as needed.  I further agree to hold the above named 
unit and its leaders blameless for any accidents that might occur during 
this outing except for clear acts of negligence or non-adherence to BSA 
policies and guidelines.

In case of emergency, I can be reached by phone at ________________ 
or ________________.  If I cannot be reached, please contact 
____________________________________ at ____________________________.


Print Name:  _________________________________________   Date: ___________
                  (Parent or Guardian)


Signed:  _________________________________________   Date: ___________
                  (Parent or Guardian)