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101 E. Wheeler Ave. Arcadia, CA 91006 (626)-445-7771 Fax (626)447-0683 |
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101 E. Wheeler Ave. Arcadia, CA 91006 (626)-445-7771 Fax (626)447-0683 |
| To be completed by the troop leader | |||||||||
| Troop Number: 12 | Activity Description: |
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| Troop Level: Bridging Cadettes |
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Troop money-earning project? |
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| Date(s): | Destination:
Sierra Madre Congregagtional Church
Old North Church |
Application Filed? |
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| Monday, June 9, 2003 | Address:
191 W. Sierra Madre Blvd
corner of SMBL and Hermosa City: Sierra Madre, CA |
Has non-member insurance been obtained? |
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| Phone: n/a | Extended troop travel insurance? |
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| Method of Transportation: private cars | |||||||||
| Departure
Location:
meet at SMCC Old North Church |
Departure
Time:
Arrive at 5:30 eat before you come |
Return
Location:
same |
Return
Time:
end of ceremony |
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| ADULT
IN CHARGE:
Barbara A. Sargent; Phone: (626).351.0852 1046 Cynthia Ave.; Pasadena, CA 91107 |
OTHER
ADULT:
Donna Matthews; 2121 Glen Springs Rd. Pasadena, CA 91107 Phone: (626).794.4167 |
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| CERTIFIED
FIRST AIDER:
Barbara A. Sargent (626.)351.0852 1046 Cynthia Ave.; Pasadena, CA 91107 Cert. Exp. Date: 10-20-04 |
LIFEGUARD:
not applicable |
CAMPING
SKILLS TRAINED ADULT:
Barbara A. Sargent (626).351.0852 1046 Cynthia Ave.; Pasadena, CA 91107 Training Exp Date: 4-26-05 |
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| Cost
per child: none
Family pays $ Troop pays $ |
Purpose of fee: | ||||||||
| Your child should bring: See separate list given at troop meeting | |||||||||
| þ
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: n/a |
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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