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Troop 7686 Consent & Emergency Form
HOSTED BY GIRL SCOUT TROOP 7686

Who: Children ages 4 (and out of diapers) through age 12
When: Thursday, September 17, 2026
Time: 4:30–8:30pm
Cost: $45/1 child; $65/2 children; $80/3 children in the same family
Where: 80 Windsor Ave, Narberth - the Girl Scout Room to the right of the library
Dinner: Pizza served for dinner, plus snacks / Gluten free pizza option available upon request

Questions? Contact us at troop7686@gmail.com

Advance payment via Venmo - @Christine-Weatherwax. All payment is final unless the event is cancelled. 

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Child #1 Name (Last, first) *
Child #1 Age *
Child #1 Food Allergies? *
Child #1 Medical Concerns? *
Child #2 Name (Last, first)
Child #2 Age
Child #2 Food Allergies?
Child #2 Medical Concerns?
Child #3 Name (Last, first)
Child #3 Age
Child #3 Food Allergies?
Child #3 Medical Concerns?
Parent./Guardian Name (Last, first) *
Parent/Guardian Address *
Phone number to use during babysitting event:
 *
Parent/Guardian Email Address
 *
Name & phone # of person picking up your child(ren) listed on this sheet (if different from parent/guardian listed above). Child(ren) will only be released to an adult named on this form. 
Name of Additional Emergency Contact:
 *
Phone of Additional Emergency Contact:
 *
Relationship of Emergency Contact to Child(ren) 
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I understand that a nurse will not be present during this activity and that any services typically performed by a nurse, including dispensing of prescription and/or over the counter medication, will need to be performed or provided by the parent/guardian.
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MEDICAL RELEASE --- I hereby waive and release the Girl Scouts of Eastern Pennsylvania and all individuals, staff members or volunteers working in connection with the listed activity from any and all possible claims for injury to person or property which might arise in connection with my child’s participation in activities sponsored or provided by you. I do not hold the Council responsible for any accident or illness which might occur and authorize the adult in charge, should it be necessary, to secure the service of a doctor at my expense. (Parent will be notified in case of an emergency.)
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I will Venmo payment and my Venmo user name is below. Please note all payment is final. 
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