To Whom It May Concern: I give permission for my son(s),

to go to Camp Crown, in Wilmot, Wisconsin with Troop 79, on August 13-15, 1999.

My son can attend the entire camp-out.

My son can only attend a portion of the campout.

My son will arrive late. I will bring him there on at o’clock.

My son must leave early. I will pick him up on at o’clock.

I, , would like to attend this camp-out.

I can assist with driving for this campout. I can drive there back both ways

My vehicle can hold Scouts and their equipment in addition to myself and my equipment

My Illinois Driver’s License number is

The make, model and year of my vehicle is

Parent’s Signature: ________________________________________________

Emergency phone numbers, medical insurance and health information has not changed from the “Personal Health and Medical Summary” form on file with the troop, except for the following:

For Scribe Use Only

Amount collected for:

$ ______ Patrol

$ ______ Troop

$ ______ Total