Pack 12 New Scout Registration Form

Primary Parent/Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Number*

Area CodePhone Number

Home Number

Area CodePhone Number

E-mail*

The best way to reach me is by:*

Cell PhoneHome PhoneEmailOther

Secondary Parent/Guardian Name

First NameLast Name

Address (please enter same if it's the same as the Primary Parent)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

E-mail

example@example.com

Please provide two Emergency Contacts:*

Rows	Full Name	Contact Number	Relationship to You
1
2

Fundraiser Understanding: In order to “Help the Pack Go,” our family understands that we need to participate in the fall and spring fundraisers or pay the opt out amount set annually by the Board. These funds are vital to helping run a successful program each year and assist in keeping annual dues low. (Note: fundraising does not apply to Lion scouts.)*

Yes

Media Release Agreement: I hereby agree and consent to the use of any photograph, voice recording, or videotape of the child (minor) named hereafter for promotional and/or publicity purposes on behalf of the Scouts, BSA and its subsidiary organizations, including but not limited to use in newspapers, broadcast media, websites, and so forth. All rights and interest in the finished product are relinquished and all rights to payment or compensation are waived.*

Yes

Scout Name*

First NameLast Name

Gender*

Date of Birth*

Date

Grade Level*

Does this scout reside at the same address as Parent/Guardian #1?*

YesNo

Address of Scout

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Major and Minor Allergies (enter None if none apply)*

Medications (enter None if none apply)*

Diagnosis (if any):

Equipment/Assistive Technology (if any):

Additional medical issues (if any):

Overall health:*

Important information for leaders to know:*

Scouts Strengths:*

Scouts Challenges:*

How does the scout learn best?*

Things to avoid?*

Additional information:

Do you have additional scouts to register?*

YesNo

Scout Name*

First NameLast Name

Gender*

Date of Birth*

Date

Grade Level*

Does this scout reside at the same address as Parent/Guardian #1?*

YesNo

Address of Scout

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Major and Minor Allergies (enter None if none apply)*

Medications (enter None if none apply)*

Diagnosis (if any):

Equipment/Assistive Technology (if any):

Additional medical issues (if any):

Overall health:*

Important information for leaders to know:*

Scouts Strengths:*

Scouts Challenges:*

How does the scout learn best?*

Things to avoid?*

Additional information:

Do you have additional scouts to register?*

YesNo

Scout Name*

First NameLast Name

Gender*

Date of Birth*

Date

Grade Level*

Does this scout reside at the same address as Parent/Guardian #1?*

YesNo

Address of Scout

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Major and Minor Allergies (enter None if none apply)*

Medications (enter None if none apply)*

Diagnosis (if any):

Equipment/Assistive Technology (if any):

Do you have additional children not in Cub Scouts?*

YesNo

Additional Child Information

Rows	First Name	Age	Registered with BSA?
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6

Our interests and pastimes include:*

A topic our family would enjoy teaching youth is:

Please check all that apply:

My job, business, or profession might be of interest to Cub Scouts.We have training or experience that might be helpful.Other

An adult in our family has first aid or safety-related training or credentials:

NoYesOther

An adult in our family has teaching, coaching, or mentoring experience:

NoYesOther

An adult in our family has previous scouting experience:

NoYesOther

An adult in our family is willing to help my child and the pack by providing behind-the-scene support such as:*

An adult in our family would be willing to help my child and the pack by assisting to present the program, perhaps serving as:*

A NOVA STEM Coordinator or NOVA STEM AssistantPart of a team helping a Cub Scout denDen Leader or Assistant Den LeaderCubmaster or Assistant Cubmaster

Our family can also help in these areas (please check all that apply):*

Special Program Resources, our family has a (please check all that apply):*

An adult in our family can help with the following program activities:*

Committee Chair: I can help recruit adult leaders for the unit, work with the Chartered Org Rep to coordinate activities which align with the expectations of the chartered organization, encourage parents to be active members of the Pack, attend monthly roundtable meetings, provide support to the Cubmaster to ensure that a quality program is delivered to the youth, work with other unit leaders, including the Treasurer, Pack Trainer, and activity chairs, hold Pack Committee meetings several times throughout the year so adults can come together and discuss the program, and help fill out the recharter paperwork.*

	1	2	3	4

1 is I want to volunteer for this, 4 is Not in my top 3

Pack Secretary: I can keep minutes for Pack Committee meetings and distribute them to the Pack Committee in a timely manner, send out notices to the Pack (either via mail or email) for upcoming Pack events and Committee meetings, keep a current copy of the Pack roster and ensure that the den leaders keep attendance for meetings, keep a list of required BSA forms and materials on hand, let the Cubmaster, Den Leaders, and other adults involved in the Pack know what forms and printed resources are available, write thank you notes to anyone who provides help to the Pack and take care of other correspondence.*

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1 is I want to volunteer for this, 4 is Not in my top 3

Cubmaster: I can deliver a quality, fun, year-round program to the Cub Pack, conduct the program according to BSA policies, receive the appropriate training, including Cubmaster specific training, attend monthly Cub Scout Roundtables to receive information about district and council policies and programs, carry out the Pack program with the support of the Pack Committee, including leading monthly pack meetings, carry out the goals of the chartering organization within the Pack program, work with the Pack Committee to recruit adult leadership, work with the Pack Committee to develop the Pack budget, support the Pack Den Leaders and encourage them to get the appropriate training, encourage the Pack Den Leaders to work toward Cub Scout Leader awards, encourage Webelos to cross over to a Scouts BSA Troop, communicate with parents about the Pack program and help to educate them about the Cub Scout program, encourage family participation in the Cub Scout program, encourage the Pack to participate in service projects, work with the Assistant Cubmasters, delegating as necessary, attend and participate in Pack Committee planning meetings, recruit Den Chiefs to assist the Pack Den Leaders, incorporate traditional Scouting elements, such as flag ceremonies, skits, and songs, into the Pack program, encourage advancement and recognize Cub Scouts when they advance.*

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1 is I want to volunteer for this, 4 is Not in my top 3

Pack Trainer: I can know the training requirements for Den Leaders, Cubmasters, and Pack Committee positions, be familiar with BSA training materials and policies, ensure that all adults registered with the Pack have met youth protection training requirements, make sure that all adults are aware of online and district training events, remind untrained adults to complete their training, make adults aware of special training opportunities, such as Pow Wows and BALOO training, assist the Cubmaster and Den Leaders with program planning, make Cubmaster and Den Leaders aware of resources which are available to help them with their programs, publicize district roundtables and encourage registered adults to attend, encourage Den Chiefs to attend Den Chief training, keep Pack training records.*

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1 is I want to volunteer for this, 4 is Not in my top 3

Part of the Pack Committee: I can help recruit new adult leaders, including the Cubmaster and one or more assistant Cubmasters. These leaders must be approved by the chartered organization.Provide a place for the Pack to meet, serve as a link between the Pack and the chartered organization, making sure the Pack functions within the mission of the Scouts, BSA and within the mission of the chartered organization, make sure the Pack charter is renewed on time annually, work with the Cubmaster to deliver a quality, year-round program to the youth and their families, maintain a Pack treasury, purchase equipment as necessary and maintain it, encourage all adults in the Pack to obtain the appropriate training for their positions, work with local Scouts BSA Troops, especially any troop under the same chartered organization, to provide a smooth transition for youth crossing from Cub Scouts to Scouts BSA.*

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1 is I want to volunteer for this, 4 is Not in my top 3

Pack Treasurer: I can collect and track dues from families, manage the funds of the pack, including: maintaining the bank account for the pack, oversee pack account at Sam Houston Area Council office, produce dues memo for den leaders and parents, accept and track dues payments,deposit checks, produce checks for pack expenses, and produce treasurer’s report for Committeemeetings. *

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1 is I want to volunteer for this, 4 is Not in my top 3

Advancements Coordinator: I can accept den advancement reports from den leaders, enter data into Scoutbook, purchase badges and other advancement items, organize badges and deliver to Cubmaster for presentation at pack meetings and Blue & Gold Dinner and Crossover, work with Cubmaster for awards ceremony at Blue & Gold.*

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1 is I want to volunteer for this, 4 is Not in my top 3

Membership Chair: I can collect membership renewal information as well as dues paid to the treasurer by families, maintain pack roster, perform charter renewal for Council (i.e. update membership using online program), and advertise the Pack during the scouting year (especially for recruiting events).*

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1 is I want to volunteer for this, 4 is Not in my top 3

Den Leader: I can guide, support, motivate, and inspire the kid in the den, I can be a strong advocate and preferably a participant in outdoor activities like camping, facilitate the den’s participation in pack meetings and pack activities, such as helping to prepare the den for Pinewood Derby, performing skits, or conducting flag ceremonies, guide the children in the den through the advancement process, keep advancement records that are also shared with the Pack Advancements Coordinator so advancements can be purchased and awarded in a timely fashion, develop a good working relationship with den parents and families and use their talents to help enrich the den experience, help ensure that the scouts participate in pack fundraising activities.*

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1 is I want to volunteer for this, 4 is Not in my top 3

Outdoor Activity Coordinator: I can work closely with the Cubmaster and Den Leaders to coordinate outside activites for field trips during the scouting year and throughtout the summer, communicate activities to the Pack at monthly Pack meetings and via social network, attend district Roundtable kick-off meeting about Day Camp, assist parents with registering for Day Camp, communicate Day Camp information/news with the pack, ensure each Day Camp attendee has the proper Health & Safety Form on file with the Pack Health Forms Coordinator and delivers these forms to the district, promote Day Camp within the pack and encourage attendance, ensure that Pack 28 has enough adult volunteers registered to meet district minimums. *

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1 is I want to volunteer for this, 4 is Not in my top 3

Pinewood Derby Coordinator: I can determine the shape and viability of the track, design the race brackets and heats, obtain scales and pit crew materials, solicit volunteers to help on the day of the event for set-up, management, and take-down, work with Cubmaster and Advancement Chair to determine awards and prizes are purchased and available, plan and coordinate a pack workshop to assist families in the construction of their own Pinewood Derby Car, research and share dates of other local Pinewood Derby workshops (Scout Shop, Lowes, etc.) with the pack.*

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1 is I want to volunteer for this, 4 is Not in my top 3

Popcorn Drive Coordinator: I can attend district kick-off meeting(s) to receive instruction, information, and materials, provide scouts with the materials to perform their sales activities, determine awards and market those awards to the scouts, provide sales training to the scouts, typically in the form of simple documentation and perhaps a skit at the Pack meeting that kicks off the fundraiser, contact local stores and coordinate dates and times for store front selling, coordinate the product distribution to the scouts, securing a drop-off/distribution point, keep track of the sales, funds, and prizes, work with the Treasurer to ensure proper review, reconciliation and disposition of the collected funds.*

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Scout Fair Coupon Book Coordinator: I can attend district kick-off meeting(s) to receive instruction, information, and materials, provide scouts with the materials to perform their sales activities, determine awards and market those awards to the scouts, provide sales training to the scouts, typically in the form of simple documentation and perhaps a skit at the Pack meeting that kicks off the fundraiser, contact local stores and coordinate dates and times for store front selling, coordinate the product distribution to the scouts, securing a drop-off/distribution point, keep track of the sales, funds, and prizes, work with the Treasurer to ensure proper review, reconciliation and disposition of the collected funds, coordinate and procure a booth for Pack at Scout Fair, ensure scouts sign up to volunteer for a shift at the Scout Fair booth.*

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1 is I want to volunteer for this, 4 is Not in my top 3

Scouting for Food Drive Coordinator: I can attend district kick-off meeting(s) to receive instruction, information, and materials, provide scouts with the materials to perform their activities, typically in the form of simple documentation and perhaps a skit at the Pack meeting that kicks off the drive, contact the council drive coordinator to coordinate the product distribution to the scouts, securing a drop-off/distribution point, and keep track of the amount of volunteers and pounds of donated items.*

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1 is I want to volunteer for this, 4 is Not in my top 3

General Fundraiser Coordinator: I can work with the Pack Committee to determine local spirit nights and exciting fundraisers, obtain permission from Sam Houston Area Council for approval of fundraiser, contact the local businesses that offer spirit nights and set up the pack for specific dates, work with the Treasurer to ensure proper review, reconciliation and disposition of the collected funds.*

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NOVA STEM Coordinator: I can promote STEM (science, technology, engineering, mathematics) actives and awards in the pack, coordinate and execute occasional pack STEM nights, be familiar with BSA STEM Nova and Supernova award requirements.*

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Health Forms Coordinator: I can organize and maintain all Health & Safety Forms for the entire pack, ensure that the pack has two copies of the Health & Safety Form for each family member who attends pack overnighters, work with the Cubmaster to give a “Safety Minute” talk at monthly pack meetings, maintain the pack’s first aid kit and bring to all pack events, follow BSA procedures for reporting incidents that occur at pack events, promote general safety at all pack events.*

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Religious Emblems Coordinator: I can attend Religious Emblem Coordinator training, be familiar with and promote religious emblem awards, assist families who are working to complete award requirements.*

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1 is I want to volunteer for this, 4 is Not in my top 3

I understand that I will be receiving a Welcome Letter, Cub Scout Glossary, and Pack Handbook by email. I agree to read through the information and discuss the handbook with my scout(s) and by returning the Signature Page to the Pack, we agree to follow the guidelines set by the Pack Committee.*

Yes

Would you like to complete the top three desired Positions of Interest for Parent/Guardian #2?*

YesNo

Committee Chair: I can help recruit adult leaders for the unit, work with the Chartered Org Rep to coordinate activities which align with the expectations of the chartered organization, encourage parents to be active members of the Pack, attend monthly roundtable meetings, provide support to the Cubmaster to ensure that a quality program is delivered to the youth, work with other unit leaders, including the Treasurer, Pack Trainer, and activity chairs, hold Pack Committee meetings several times throughout the year so adults can come together and discuss the program, and help fill out the recharter paperwork.*

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