Summer Camp 2023
Name
*
First Name
Last Name
BSA member ID
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
*
Male
Female
Special Needs
any physical, dietary or special needs
Emergency Contact
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
*
Additional Information
Scout Rank
*
Please enter the rank your scout will be in the summer of 2023. Ex: If they were a bear during March 2023, they will be a webelos in June 2023
Parent Name
I understand that I will not be registered by the pack until all money owed is turned in.
Signature
*
Submit
Submit
Should be Empty: