2018 TEXAS Dog Scout Camp Registration Form

Camp Dates: Nov. 10-13, 2022 at Lakeview Camp & Retreat Center, Waxahachie, TX

Note: Camp fee for one camper and one dog is $525, a deposit of $100 is required to hold your spot, the balance fee is due 60 days prior to camp.

Is my dog appropriate for a group camp experience?
In general, as long as you are both willing and able to keep your dog sufficiently managed/under control to prevent your dog from negatively impacting others’ safety or enjoyment, they are welcome to attend. We do reserve the right to remove dogs from camp if this is not the case, but will first work with you to help resolve issues if possible. We do encourage you to consider whether your dog may be too fearful or reactive to *enjoy* the camping experience, and if so, to leave this dog at home. Please feel free to contact us with any questions.

First name of Camper: *

Last name of Camper: *

E-mail

Address

Street Address

Street address 2

City State

Zip Code

Phone Number

Area Code Phone Number

Cell Phone Number

Area Code Phone Number

DSA membership

My membership will be current during camp

Emergency contact name (someone not attending camp with you):

Relationship of the emergency contact to you:

Emergency contact's phone number with area code:

Do you have any health concerns we should be aware of (diabetic, heart condition, seizures, allergy that requires epi-pen, etc.)?

Do you have any dietary concerns/requests?

Names of people you would prefer to room with:

Please select your T-Shirt size (unisex)

Small Medium Large Extra Large

I understand a deposit of $100.00 is required to hold my spot. *

yes

I understand the deposit is non-refundable unless the event is cancelled. *

yes

I agree to pay the full camp fee at least 60 days prior to the start of camp. *

yes

I understand that funds paid within 90 days of camp are not refundable unless I find a replacement to take my place. *

yes

I understand that I will not be allocated additional cabin space if I bring an additional dog. (There is a $125 fee for an additional dog and you must receive prior approval.) *

yes

Dog Information

Dog's call name:

Dog's breed (or best guess).

Dog's gender

Male neutered Male intact Female Spayed Female intact

Dog’s date of birth (or best guess)

Dog's approximate weight:

Is your dog a Dog Scout?

Yes Not Yet

Dog's general level of training

None Basic/Novice level Intermediate Advanced

Has your dog been around several other dogs at once? If so, where? And was your dog on leash or off?

List any issues your dog may have with other dogs (or put none):

Has the dog you plan to bring ever bitten anyone? If yes, please explain:

Has the dog you plan to bring been attacked by another dog or caused injury to another dog? If yes, please explain:

Please note any dogs that would not be good roommates for your dog:

What do you feed your dog? (select all that apply)

dry food (kibble) wet food (canned) freeze dried/dehydrated homemade or raw (refrigerated)

Payment Information

Note: You must pay the $100 non-refundable deposit to reserve a spot at Mini-Camp

Checks, money orders and Zelle are accepted.

Please mail your check or money order (payable to DSA Troop 119) to:

Mart & Cindy Ratliff

3929 Chestnut Street

Ft Worth, TX 76137

For Zelle payments please use the following phone number: 817-821-5826 (no email)

Please verify that you are human *

Texas Dog Scout Mini-Camp Registration Form 2022