| Hopkins District Cub Scout Day Camp 2009 � An all-volunteer program �Cubs in Space�Transportation Form Scout Name (goes by)_________________________________________________________________ Street Address______________________________________________________________________________ City/State/Zip Code_________________________________________________________________________ Home Phone Number________________________________________________________________________ Father�s Name_____________________________ Mother�s Name_____________________________ Father�s Home Phone_______________________ Mother�s Home Phone_______________________ Father�s Work Phone_______________________ Mother�s Work Phone________________________ Father�s Cell Phone_________________________ Mother�s Cell Phone_________________________ Father�s Pager_____________________________ Mother�s Pager_____________________________ The additional following people have my permission to transport my child to and/or from Hopkins District CSDC 2009, held at Clifton Park. Name_____________________________________________________________________________________ Relationship_______________________________________________________________________________ Phone Number_____________________________________________________________________________ Name_____________________________________________________________________________________ Relationship_______________________________________________________________________________ Phone Number_____________________________________________________________________________ Name _______________________________________________________________________________ Relationship_______________________________________________________________________________ Phone Number_____________________________________________________________________________ Name_____________________________________________________________________________________ Relationship_______________________________________________________________________________ Phone Number_____________________________________________________________________________ Name_____________________________________________________________________________________ Relationship_______________________________________________________________________________ Phone Number_____________________________________________________________________________ Name_____________________________________________________________________________________ Relationship_______________________________________________________________________________ Phone Number_____________________________________________________________________________ *** Note: No one is allowed to transport your child from Camp but his or her parents/guardians or those persons listed above. Parent Signature:___________________________________________________ Date:___________________ (not valid without Signature) | 
