Dear Parents: Date: January 15-16 2011
Our club is planning to go on a trip to Camp Killoqua on January 15-16 (Saturday to Sunday) Time of Departure:6:30pm (Saturday). Place of Departure: above noted location. Time of Return: 10:00 am (Sunday). Place of Return: Same. Cost of Trip: $13.00 for overnight lodging and meals. Food: Dinner and breakfast provided; you can bring your own snacks, too. Misc.: Be sure to bring overnight gear such as a sleeping bag, etc. You can also bring camp-appropriate music for the evening.
We are also in need of sewing machines, with extra thread, bobbins, and needles. Desk lamps, and scissors.
* Please RSVP to Cassie at the phone or e-mail below. Check in with me at MdeYaTa when you arrive (there will be a sign on the office door telling you where to go).*
Discovery and Horizon clubs must be
accompanied at all times by a minimum of two adults 18 years of age or older. Clubs or activities with more than 20 youth must
be supervised by an additional adult for every 10 youth.
*an
adult is age 18 or older with the exception of the Apprentice Club Leader who is 15
through 17 years old, has completed club leader training and has on-going supervision.
The drivers are: NONE
If there is any
undue delay in getting home, I will get in touch with: Camp Killoqua, 360-652-6250
The section at bottom of this form must be signed and returned to me before your child
goes on the trip. If there is any condition
of health that should be watched for while on the trip, please include a statement on it.
Leader's Signature: Cassie Anderson
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I am familiar with the proposed destination, the mode of
transportation, the leadership accompanying the club, that all drivers are licensed and at
least 21 years old, and other circumstances of this activity. I certify that my child is in good health and can
participate in all the normal activities of the club. (State any exceptions below). I understand that reasonable measures will be
taken to safeguard the health and safety of the members and that I will be notified as
soon as possible in case of an emergency. However,
in the event of sickness or accident, I will not hold the club leaders or Camp Fire
responsible. In case of sickness or accident,
I authorize the calling of a doctor and/or the providing of other necessary medical
services at my expense.
Phone
Address
Date
Person
other than parent (for emergency use):
______________________________________________________________________________
Name
Phone
Name of Family Physician____________________________________________________________
Insurance Provider and Policy # _______________________________________________________