Cost: $15 Including a Fun Patch (For Registered Girls)

Girl Scouts of Nassau County

SEAFORD/WANTAGH ASSOCIATION OF GIRL SCOUTS

What: Paint Night

Date: Friday, March 4, 2016 @ 7:00 pm- 8:30 pm

Friday, April 8, 2016 @ 7:00 pm – 8:30 pm

Friday, April 15, 2016 @ 7:00 pm – 8:30 pm

Who: All levels

Where: Seaford Middle School

Cost: $15 – including a fun patch (for registered girls)

**Includes canvass, all supplies and instruction**

**Space is limited, registration is ‘first come first served’**

LEADERS

 Join us for a fun night of painting!

 Submit one Troop check made payable to Seaford/Wantagh Association of Girl Scouts

 Please supply a list of names of the girls and adults attending

 Registration: Checks must be submitted 5 days prior to the event

 Adult coverage needed as per GSUSA Safety Activity Checkpoints.

 Permission Slips must be filled out and brought to the event & held by chaperone.

Event Chair: Nancy Setzler – or cell/text 516-359-8289

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I give permission for (Girl’s Name) ______Troop #______

to attend Paint Night , Seaford Middle School • 3940 Sunset Ave • Seaford, NY 11783 on ☐ Mar 4th or ☐Apr 8th or ☐Apr 15th.

I shall allow her to attend only if she is in good physical condition at the time of her departure. I shall be responsible for meeting her on time at the place of return.

Please see that my child receives the medication(s)______

In the following dosage ______frequency______

For conditions(s) ______

In case of illness or injury, the adult in charge will make every effort to contact me or the emergency adult listed below. If I cannot be reached, you have my permission to take my child to a doctor or hospital by whatever means of transportation is available. I hereby authorize the doctor or hospital to administer whatever emergency medical treatment is in the opinion of the doctor, needed.

Please print name and telephone number:

Parent/Guardian______Telephone ______

Emergency Adult ______Telephone ______

Child’s Physician ______Telephone ______

Parent/Guardian Signature ______Date ______