Trip,Outing or Merit Badge Name * Trip or Outing dates: * Scouts Name * Scouts Current Patrol: * All Parents Phone Numbers: * Parents email address: * Emergency Contact Name (other than parent): * Emergency Contact Phone Numbers: * Trip Cost (bring to troop meeting): * Payment by Check? (select only one method of payment) Yes No Payment by Cash? Yes No Payment by Troop Bucks? Yes No My Son DOES currently take medication or have health information the Scoutmaster needs to be aware of: * True False If Medication or Medical info needs to be given to the Scoutmaster, please list it here: Comments:

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