Troop 52, BSA

Swansea, IL

I, ______________________________ , request permission to participate in the following

activity toward satisfying the Community Service Time requirements for __________________.

(List Requirement)

Name of Activity: ______________________________________________________________

Description of Activity:

______________________________________________________________________________

______________________________________________________________________________

_____________________________ _________________

Scout Signature (Date)

The above request is approved/disapproved.

___________________________________

Scout Master Signature or Designated Representative

I, _______________________________________, certify the above community service

(Name of Parent/Guardian)

time was performed as stated above for ____________ hours.

________________________________ _______________

Parent/Guardian Signature Date