DATE: ____________________

Scout's Name: ________________________________________
                                                      (Please Print Scout's Name)

I hereby certify that my son and I have reviewed the pamphlet entitled: "How to Protect Your Children from Child Abuse and Drug Abuse: A Parent's Guide" (found on the inside cover of the Scout Handbook), as of the above date.

Please complete this discussion and return this form to the Scoutmaster as soon as possible. Note that your son cannot advance to Scout Rank until the Troop has received this form. Thank you.

Troop 111 Homepage.
11 January 1998