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101 E. Wheeler Ave. Arcadia, CA 91006 (626)-445-7771 Fax (626)447-0683 |
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| To be completed by the troop leader | ||||||||||||||||||
| Troop Number: 12 | Activity
Description:
Weekly meeting location temporary change |
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| Troop Level: Cadette/Senior |
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Troop money-earning project? |
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| Date(s): Mondays | Destination: Vesseys' Home | Application Filed? |
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| Starting October 13, 2003 | Address: 1405 Rancho Rd. ; Arcadia CA 91006 | Has Non-member insurance been obtained? |
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Phone: 626.836.3639 |
Extended troop travel insurance? |
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| Method of Transportation: self | ||||||||||||||||||
| Departure
Location: 1405 Rancho Rd.; Arcadia CA |
Departure
Time:
arrive at 3:45 p.m. |
Return
Location: same |
Return
Time: pick up at 5:30 p.m. |
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| ADULT
IN CHARGE: Barbara A.
Sargent
626.351.0852 1046 Cynthia Ave; Pasadena, CA 91107 |
OTHER
ADULT: Donna
Matthews 626.794.4167 2121 Glen Springs Rd; Pasadena, CA 91107 |
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| CERTIFIED
FIRST AIDER: Barbara A. Sargent 626.351.0852 1046 Cynthia Ave; Pasadena, CA 91104 Cert. Exp. Date: 10-20-04 |
LIFEGUARD:
not applicable |
CAMPING
SKILLS TRAINED ADULT: Barbara A. Sargent 626.351.0852 1046 Cynthia Ave; Pasadena, CA 91104 |
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| Cost
per child: $none Family pays $ none Troop pays $ balance |
Purpose
of fee: |
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| Your
child should bring: Permission
slip, wear sport clothing, dues, Badge Book |
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| I have reviewed Girl scout procedures for
this activity and comply with
Safety - Wise and Girl Scouts - Mt. Wilson Vista Council policies.
Signature of
Troop Leader: |
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| IN
CASE OF EMERGENCY, THE ADULT IN CHARGE WILL CALL THIS PERSON WHO WILL
GET
IN TOUCH WITH ALL PARENTS: Name: Barbara A. Sargent Home Phone: 626. 351. 0852 Cell Phone: (David) 626. 533. 7523 |
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| Service
Unit Manager signature required for overnight trips:
Signature of Service Unit Manager: Date: |
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Phone Number: (626) , 351 , 0852