Girl Scouts F204 Form PDF Details

In the world of Girl Scouts, ensuring the safety and preparedness of each member for various activities is paramount. The Girl Scouts F204 form plays a crucial role in this, acting as a permission slip linked with the Girl Scout Medical Information Form. As part of the detailed protocols by the Girl Scouts of San Jacinto Council, this document covers all essential aspects of a Girl Scout's participation in activities, including medical treatment authorization, financial responsibility for medical expenses, consent for public relations use of photographs, voice, and/or video, and terms regarding transportation. It emphasizes the importance of parental or guardian consent for activities occurring outside the regular meetings, placing responsibility for transportation squarely on the parents, while also absolving the council of any liability related to transportation. Furthermore, the form allows for the specification of activities in which the child can participate, including more rigorous ones like boating or horseback riding, with space for noting exceptions. Additionally, it accounts for emergency contact information, medication instructions, and insurance coverage — fostering a thorough approach to ensuring each girl's safety and well-being. This comprehensive form, therefore, not only facilitates smooth operational logistics but also reinforces the commitment of the Girl Scouts to fostering a secure and enriching environment for all its members.

QuestionAnswer
Form NameGirl Scouts F204 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesgirl scout permission slip, F-204, girl scout printables, gssjc permission form

Form Preview Example

Use this form ONLY with Girl Scout Medical Information Form (GSSJC F-185 Rev. 05/05)

 

 

 

 

 

 

 

GIRL SCOUT PERMISSION SLIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Girl Scouts of San Jacinto Council

 

 

 

 

 

 

 

 

 

 

 

 

 

(THIS FORM MAY BE PHOTOCOPIED WHEN COMPLETED. PRINT CLEARLY, USE BLACK INK.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GIRL’S NAME

 

 

 

 

 

 

TROOP/GROUP #

 

 

 

 

 

 

 

Parent/Legal Guardian to keep this portion

 

 

 

 

 

 

 

Activity/Place:

 

 

Date(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leaving from:

 

Time of departure:

 

 

 

 

Returning to:

 

Time of return:

 

 

 

 

 

Bring:

 

 

 

 

 

 

 

 

Fee:

Dress:

 

 

 

 

 

 

 

 

 

 

Adult in charge:

Phone:

(

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact adult:

 

Phone:

(

 

 

)

 

 

 

 

 

 

 

 

 

Cut above and return this portion to leader/adult in charge by:

 

 

 

 

 

 

(Date)

Girl's Name:

Troop/Group #

 

 

 

Age:

Activity:

 

 

 

 

 

Date:

My daughter has my permission to attend the activity listed above. She will not attend if she is not feeling well. I give my permission to have her treated by a licensed physician if necessary. I also agree to be financially responsible for all expenses associated with providing medical care for my child. My signature on this document also allows Girl Scouts to use photographs, voice, and/or video of my child for Public Relations purposes. My daughter may have opportunities in the future to attend activities other than the ones listed on this form. I acknowledge that if I give permission for her to participate in such activities in the future, it is under the same conditions that are set out in this form, including with respect to transportation. (Leader: Attach future parent permissions to this form.)

TRANSPORTATION RELEASE: I understand that troop/group leaders must obtain the written consent of parent/guardian for every girl wishing to participate in an activity or outing that is held at a different place and time from the regularly scheduled troop/group meeting. I accept responsibility for the transportation of my child to and from any Girl Scout activity and recognize that transportation to and from Girl Scout events is not the responsibility of Girl Scouts of San Jacinto Council. I recognize that the driver of any such carpool or bus service that I arrange is not acting as an agent of Girl Scouts of San Jacinto Council. It is my expressed intention to hold Girl Scouts of San Jacinto Council harmless for any and all injuries, death or damages arising from or in any way related to any such transportation.

I give my permission for my daughter to participate in Boating, Swimming, Horseback Riding, or other strenuous activities. If no exceptions, she may participate in all activities at this outing. EXCEPTIONS:

My daughter may not be released to:

If unable to reach me in case of an emergency or change in plans, please contact one of the following. I will make arrangements with these people prior to the event.

Name:

Day:(

)

Evn:(

)

Relationship:

Name:

Day:(

)

Evn:(

)

Relationship:

I have provided medication(s) for my child to take with the supervision of the Leader/First Aider. Yes:

 

No:

(attach a list if necessary)

Medication:

Dosage:

How Often:

Medication(s) she can have: _____________________________________________________________________________________________________________

Medication(s) she cannot have:___________________________________________________________________________________________________________

Disease exposed to in last 30-days: _______________________________________________________________________________________________________

Signature of Parent/Legal Guardian

Phone #

Pager or Cell Phone

Date

______________________________________________________

 

 

 

Print Name of Parent/Legal Guardian

 

 

 

 

GIRL SCOUT INSURANCE CARRIER:

MUTUAL OF OMAHA

For confirmation, contact Girl Scouts of San Jacinto Council 713-292-0300 or 1-800-392-4340

GSSJC F-204

 

 

 

Rev. 05/05

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Completing this form requires focus on details. Make sure that each and every blank is done correctly.

1. It is very important complete the GSSJC properly, so take care while filling in the sections including these particular fields:

Step number 1 of completing permission

2. Once your current task is complete, take the next step – fill out all of these fields - Girls Name Activity My daughter, Relationship, Relationship, Day, Day, Evn, Evn, I have provided medications for my, Medication, Dosage, How Often, Medications she can have, Pager or Cell Phone, Phone, and Date with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Step number 2 for filling out permission

When it comes to Relationship and Day, ensure that you get them right here. These two are the most significant ones in this file.

3. The following part is usually pretty easy, - all of these blanks will need to be filled out here.

How you can prepare permission part 3

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