2021 Utica Application

Application & $50 non-refundable deposit DUE 3/23
APPLICATION

TROOP SIX SUMMER CAMP Utica 2021
At Utica scouts have an opportunity to learn about the outdoors, practice working together, develop self-reliance, and have fun. We do this by camping, cooking, swimming, backpacking, etc in this wilderness setting. Patrol leaders, senior scouts, and the adult staff are responsible for the running of camp. We all need to look after the safety and welfare of each other, pitch in when work needs to be done, and be good campers. I have read the above information, will do my best to obey the rules and make camp successful.
CHECK ALL BOXES THAT APPLY:

Scout: I wish to attend summer camp from July 3 - July 17 at a cost of $350Patrol Leader: I wish to attend precamp + summer camp from June 26 - July 17 at a cost of $350Senior Scout: I wish to attend precamp + summer camp from June 26 - July 17 at a cost of $300Special circumstances beyond my control (or cost hardship) - I will talk with Tom.
Name of Scout, PL Senior, or Staff*
Signature of Scout, PL Senior, or Staff*

Clear
FOR PARENT OR GUARDIAN
This application meets with my approval and I release Troop Six, its agents and officers, from responsibility for accident or illness incurred by my son during the period he attend camp. / understand he must be approved for camp activity by a physician within the last year. In caseof emergency requiring immediate medical attention, and when I cannot be reached in reasonable time, I authorize the troop staff and the attending physician to proceed with such actions as the physician deems necessary.
Name of Parent or Guardian*
Signature of Parent or Guardian*

Clear
Date

MonthDayYear
Date
EMERGENCY CONTACTS:
Please list at least 3 emergency contacts (names and phone numbers) we can call in case of emergency.*
ANYTHING SPECIAL WE SHOULD KNOW?
Anything we need to know about your camper before camp?*
TURN IN this whole form to the August Fern via email or at a troop meeting by 3/23. Medical form & balance of cost due by Tuesday, 5/18. Deal with Medical form now. If late, add $50.

Please pay by check (payable to: Troop 6, BSA) or PayPal at payment@troopôberkeley.org. (Please be sure to send as Family and Friends (NOT paying for a good or service) so the Troop isn't charged a big transaction fee.
UTICAmp - Troop Six - Herms District - Mt Diablo Silverado Council - Boy Scouts of America
Should be Empty:

APPLICATION

FOR PARENT OR GUARDIAN

EMERGENCY CONTACTS:

ANYTHING SPECIAL WE SHOULD KNOW?