2019 Oktoberfest Babysitting Consent & Emergency Form
Who: Children ages 4 (and potty trained) through age 11

When: Saturday, October 5, 2019

Time: 5:00–9:00 pm

Cost: $30/1 child; $50/2 children; $65/3 children; $10 each add'l child in the same family

Where: Narberth Borough Hall; 100 Conway Ave., 2nd floor, Narberth PA, 19072 – next to the firehouse

Dinner: Pizza served at 6:30pm; Gluten free option available upon request


Payment can be made on PayPal to gstroop71083@gmail.com, or with cash the evening of the event. Please select the pay to friends options in PayPal.

If you have any other questions, email gstroop71083@gmail.com
Any special instructions that students and/or chaperones are capable and qualified to address:
Your answer
Child #1 Name (Last, first) *
Your answer
Child #1 Food Allergies *
Your answer
Child #1 Medical Issues *
Your answer
Child #1 is a registered Girl Scout *
Child #2 Name (Last, first)
Your answer
Child #2 Food Allergies
Your answer
Child #2 Medical Issues
Your answer
Child #2 is a registered Girl Scout
Child #3 Name (Last, first)
Your answer
Child #3 Food Allergies
Your answer
Child #3 Medical Issues
Your answer
Child #3 is a registered Girl Scout
Child #4 Name (Last, first)
Your answer
Child #4 Food Allergies
Your answer
Child #4 Medical Issues
Your answer
Child #4 is a registered Girl Scout
Parent/Guardian Full Name *
Your answer
Parent/Guardian Address *
Your answer
Phone number(s) to use during babysitting event: *
Your answer
Parent/Guardian Email Address *
Your answer
Name of person and phone number responsible for picking up your child(ren) listed on this sheet (if different from parent/guardian listed above)
Your answer
Name of Additional Emergency Contact: *
Your answer
Phone of Additional Emergency Contact: *
Your answer
Relationship of Additional Contact to Child(ren) *
Your answer
I understand that a nurse may 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. *
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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