TROOP 628, B.S.A. ST.DOMINIC’S R.C. CHURCH 2001 BAY RIDGE PARKWAY BROOKLYN, N.Y. 11204 259-4636 “Permission Slip” I, , give permission for my son , (parent signature) to attend a camping trip from Friday, Sept 24 to Sunday, Sept 26 with Troop 628. I understand that my son is responsible for his own equipment as well as any Troop equipment he uses. I agree that restitution will be made for anything that is lost or damaged. This weekend the Troop will be staying at Camp: Pouch in Staten Island N.Y. The cost for this outing is $20.00 per person. In case of emergency, list who we should contact: Name Telephone # Name Telephone # Family Doctor’s Name Telephone # List all allergies, medications, etc. (Reading and Signing is Optional) To Whom it May Concern, In the event of an emergency, should you be unable to contact me. I, , authorize the adult leaders of Troop 628 to act on my behalf, for the safety and welfare of my son, Assistant Scoutmaster’s Signature Name: Car Holds # of Scouts. __ I am available on Friday, to drive the Troop to Camp at 6:30pm __ I am available on Sunday, to pick the Troop up at Camp at 11:45am Home(718)837-7433   Work (212)885-3269