IN-COUNCIL CAMP USE REQUEST FORM

BLACK WARRIOR COUNCIL FACILITY USE REQUEST FORM

Black Warrior Council, BSA - Serving West Alabama
Choose the facility*

Leroy McAbee Scout Service Center
- The Facility Use Permit MUST BE submitted at least 2-weeks prior to use of facilities. Any payments for facilities must be paid at least 5-days before arriving at Facility to insure use of facilities.
- Although the Black Warrior Council will make every attempt to avoid canceling an approved permit, we retain the right to do so.
- Only a registered Unit Leader or Advisor, 21 years of age or older, may submit a Facility Use Permit.
- It is the responsibility of the registered Unit Leader or Advisor to see that all Youth Protection guidelines and the standards as listed in the most current printing of BSA’s Guide to Safe Scouting are adhered to. ALL adults that will be staying on the property MUST be current with Youth Protection Training.
- The Facility Use Permit must be signed by the registered Unit Leader or Advisor and the Council Program Director.

UNIT INFORMATION
Type of Unit*
Unit Number*
Council*
District*
Name of Event*
Arrival Date & Approximate Arrival Time*

MonthDayYear
DateHourMinutesAM/PM Option
Departure Date & Approximate Departure Time*

MonthDayYear
DateHourMinutesAM/PM Option
# of Youth*
# of Adults *
Minimum of 2

FACILITIES REQUESTED
Leroy McAbee Scout Service Center*

BoardroomEagle Plaza
Leroy McAbee Service Center COUNCIL OR DISTRICT USE *Please select the locations that you would like to use*

BoardroomEagle Plaza

GENERAL RULES AND PROCEDURES WHILE ON PROPERTY
- The Leader in charge will check-in upon arrival. Check-in can be accomplished by calling the Council Program Director @ 205-554-1680.
- No pets are allowed at any time.
- No alcoholic beverages or illegal drugs of any kind are permitted on the premises.
- Everyone must follow the Scout Oath and Law at all times.
- Speed limit is 10 miles per hour at all properties.
- All vehicles will be parked in designated areas. No Scouts/Adults are permitted to ride in the back of a truck, open trailer, or back of an ATV. All ATVs MUST be inspected and approved by the Council Program Director.
- Scouts will always use the “Buddy System” while on property.
- Groups will be charged a $25 cleaning fee for putting trash in the CARDBOARD dumpster. Trash goes in the dumpster in the end of the parking lot.
- All Black Warrior Countil, local, state, and national health and safety standards MUST be adhered to.
- Before departing, each group must clean up all areas used and check-out with the Professional locking up.
- ALL adults MUST have be current with Youth Protection training.
Rules and Procedures acknowledgement*

I have read the rules and procedures above and agree to abide by them.

LEADER / ADVISOR INFORMATION
Leader / Advisor Name*

First NameLast Name
E-mail*
Cell Phone Number*

Area CodePhone Number
Youth Protection Expiration Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Assistant Leader / Advisor Name*

First NameLast Name
Cell Phone Number*

Area CodePhone Number
Email
example@example.com
Youth Protection Expiration Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please include details about your activity and include any questions or comments you may have:

As the Leader/Advisor in charge of this group, I understand my responsibilites as listed in the most current printing of the Guide to Safe Scouting, Youth Protection Policies, and the procedures listed on this form. It is also understood, that any willful property damage or damage by negligence is the responsibilty of my unit/lodge/district, and all costs to rebuid or repair such property will be our responsibility.
Signature*

Clear
*
Should be Empty:

BLACK WARRIOR COUNCIL FACILITY USE REQUEST FORM