Scout Name *

Scout Patrol *
—Please choose an option—RacoonsLaser SharksSpartansLeadershipNo Scout, Adult OnlyOther

Your Name *

Your Phone Number *

Your Email (required)

Will an Adult Attend Campout *
Please note that adults who drive and camp, fees are for food only as troop will cover your camping fee. However, you will NOT be reimbursed for Gas/Mileage unless you pull the Trailer
Yes, $0 and Tow TrailerYes, adult not participating in shooting sports $20 (Covers camp fees and food cooked by Troop)Yes, required parent of a Webelo cub scout $20 (Covers camp fees and food cooked by Troop)Troop Master Betz - $0Adult will not attendOther:

How many Scouts can you transport? *
If an adult is driving, how many scouts can fit in the car (include your scout/s)

Scout Registration *

includes Camping, Meals cooked by Troop, Shooting range fees and ammunition

Scout $35Webelo Scout $25Other:

Payment Option *

After you complete this form, a response will be sent with further payment instructions.

Scout AccountCheck or Cash 1 week before campoutPaypal via Treasurer@bsatroop475.info

Medical Health Forms Up To Date? *

I know my Scout's and/or Medical Health Forms are up to date and turned in

YesNo, we will hand them in one week prior to campout

Emergency Contact (Name/Relationship/Phone) *

Please provide the full name, relationship to the scout and phone number for your primary emergency contact

Alternate Contact (Name/Relationship/Phone) *

Please Provide the full name , relationship to the scout and phone number for your alternate emergency contact

Scout-Allergies/Drug Reactions *

If none write none

Scout-Recent Illnesses *

If none write none

Scout-Current Prescription Drugs *

If none write none

Informed Consent of Parent or Guardian *

My Scout(s) listed above has my (parent/guardian) permission to participate in the Troop 475 planned activity. I certify that my son is in good physical condition, and authorize the leaders to seek medical care for my son should it become necessary. To aid the leaders, should my son need over the counter medicines (Tylenol, Benadryl, Imodium AD, sunscreen &/or other topical medication et. al) I provide my authorization. To aid with emergency medical assistance which may become necessary, I have listed above any known ALLERGIES, DRUG REACTIONS, RECENT ILLNESSES, CURRENT PRESCRIPTION DRUGS being taken, and any other information which may help a medical professional. PARENT ACKNOWLEDGEMENT: I acknowledge that I have read and understand the above disclosure. I also acknowledge that I have read, and digitally signed, and understand the Troop 475 Annual Permission form, and that all of the information I provided is true and correct. I state that I have the authority to sign this acknowledgement, as well as the Annual Permission form. I agree my son may participate in the above event or outing, and in the planned activities, as well as in the activities normally associated with this type of event or outing (for example: packing and unpacking clothing and equipment, travelling in adult leaders’ and chaperones’ vehicles, eating, cooking, cleaning, building and extinguishing fires, setting up and taking down equipment, working on rank advancement and merit badges, and the like). I further agree that I will drop off and pick-up my son at the indicated times and locations, unless I have made other prior arrangements with the above adult leaders. I understand that my son has duties he must perform as part of the troop, consent to his performing those duties, and agree to not interfere with his performance of those duties.

I Agree