Register: Cub Scout Day Camp! Online Registrations OPEN NOW!Cub/Tiger Scout Event

» A Medical Form is required. Download a form from scouting.org to fill out.

Please fill out the following form to sign up for this event. You may register up to 6 youth and adults. If payment is required, you may pay by PayPal (PayPal charges a 3% processing fee) or by sending a check to the Council Office. Options for payment will be listed after you submit the form below.

Questions? Contact the Council Office.

Date:

Total Registrants:

required

$155.00

Registrant 1

This Registrant is an Adult.

This Registrant is a schoolmate (not a registered scout at this council). +$5

Please note: If the adult registering is not a parent, a Medical Form will be required for the scout and/or schoolmate registering. Download a form from scouting.org to fill out.

First Name

Last Name

School

Grade

Adult Contact

Relationship

Phone

Address

City

State

Zip

Sign this registrant up for escort service

	Pick up at TBD	Drop off at TBD
Monday, June 17
Tuesday, June 18
Wednesday, June 19
Thursday, June 20
Friday, June 21

I give my permission for this registrant to walk between TBD and Dracena Park, Piedmont with the Day Camp Staff.

Is your son a Reg'd Cub Scout? (yes/no)

Signing up for Schoolmates escort service? (yes/no)

Youth T-shirt size? (M/L/XL)

Are you available to help out at Camp? (yes/no)

My son is Reg'd in Pack #:

Grade he will be entering (fall 2013)?

Emergency Contact Name and #:

List any allergies we need to be aware of for your son:

Medical Insurance Company:

Insurance Policy Number:

Is your son allowed to walk home after camp?

Name of your son's Physician:

Physician's Phone #:

Any special medications that we should be aware of?

Additional Notes

required

$155.00

Registrant 2

This Registrant is an Adult.

This Registrant is a schoolmate (not a registered scout at this council). +$5

Please note: If the adult registering is not a parent, a Medical Form will be required for the scout and/or schoolmate registering. Download a form from scouting.org to fill out.

First Name

Last Name

Copy registration information from Registrant 1

School

Grade

Adult Contact

Relationship

Phone

Address

City

State

Zip

Sign this registrant up for escort service

	Pick up at TBD	Drop off at TBD
Monday, June 17
Tuesday, June 18
Wednesday, June 19
Thursday, June 20
Friday, June 21

I give my permission for this registrant to walk between TBD and Dracena Park, Piedmont with the Day Camp Staff.

Is your son a Reg'd Cub Scout? (yes/no)

Signing up for Schoolmates escort service? (yes/no)

Youth T-shirt size? (M/L/XL)

Are you available to help out at Camp? (yes/no)

My son is Reg'd in Pack #:

Grade he will be entering (fall 2013)?

Emergency Contact Name and #:

List any allergies we need to be aware of for your son:

Medical Insurance Company:

Insurance Policy Number:

Is your son allowed to walk home after camp?

Name of your son's Physician:

Physician's Phone #:

Any special medications that we should be aware of?

Additional Notes

required

$155.00

Registrant 3

This Registrant is an Adult.

This Registrant is a schoolmate (not a registered scout at this council). +$5

Please note: If the adult registering is not a parent, a Medical Form will be required for the scout and/or schoolmate registering. Download a form from scouting.org to fill out.

First Name

Last Name

Copy registration information from Registrant 1

School

Grade

Adult Contact

Relationship

Phone

Address

City

State

Zip

Sign this registrant up for escort service

	Pick up at TBD	Drop off at TBD
Monday, June 17
Tuesday, June 18
Wednesday, June 19
Thursday, June 20
Friday, June 21

I give my permission for this registrant to walk between TBD and Dracena Park, Piedmont with the Day Camp Staff.

Is your son a Reg'd Cub Scout? (yes/no)

Signing up for Schoolmates escort service? (yes/no)

Youth T-shirt size? (M/L/XL)

Are you available to help out at Camp? (yes/no)

My son is Reg'd in Pack #:

Grade he will be entering (fall 2013)?

Emergency Contact Name and #:

List any allergies we need to be aware of for your son:

Medical Insurance Company:

Insurance Policy Number:

Is your son allowed to walk home after camp?

Name of your son's Physician:

Physician's Phone #:

Any special medications that we should be aware of?

Additional Notes

required

$155.00

Registrant 4

This Registrant is an Adult.

This Registrant is a schoolmate (not a registered scout at this council). +$5

Please note: If the adult registering is not a parent, a Medical Form will be required for the scout and/or schoolmate registering. Download a form from scouting.org to fill out.

First Name

Last Name

Copy registration information from Registrant 1

School

Grade

Adult Contact

Relationship

Phone

Address

City

State

Zip

Sign this registrant up for escort service

	Pick up at TBD	Drop off at TBD
Monday, June 17
Tuesday, June 18
Wednesday, June 19
Thursday, June 20
Friday, June 21

I give my permission for this registrant to walk between TBD and Dracena Park, Piedmont with the Day Camp Staff.

Is your son a Reg'd Cub Scout? (yes/no)

Signing up for Schoolmates escort service? (yes/no)

Youth T-shirt size? (M/L/XL)

Are you available to help out at Camp? (yes/no)

My son is Reg'd in Pack #:

Grade he will be entering (fall 2013)?

Emergency Contact Name and #:

List any allergies we need to be aware of for your son:

Medical Insurance Company:

Insurance Policy Number:

Is your son allowed to walk home after camp?

Name of your son's Physician:

Physician's Phone #:

Any special medications that we should be aware of?

Additional Notes

required

$155.00

Registrant 5

This Registrant is an Adult.

This Registrant is a schoolmate (not a registered scout at this council). +$5

Please note: If the adult registering is not a parent, a Medical Form will be required for the scout and/or schoolmate registering. Download a form from scouting.org to fill out.

First Name

Last Name

Copy registration information from Registrant 1

School

Grade

Adult Contact

Relationship

Phone

Address

City

State

Zip

Sign this registrant up for escort service

	Pick up at TBD	Drop off at TBD
Monday, June 17
Tuesday, June 18
Wednesday, June 19
Thursday, June 20
Friday, June 21

I give my permission for this registrant to walk between TBD and Dracena Park, Piedmont with the Day Camp Staff.

Is your son a Reg'd Cub Scout? (yes/no)

Signing up for Schoolmates escort service? (yes/no)

Youth T-shirt size? (M/L/XL)

Are you available to help out at Camp? (yes/no)

My son is Reg'd in Pack #:

Grade he will be entering (fall 2013)?

Emergency Contact Name and #:

List any allergies we need to be aware of for your son:

Medical Insurance Company:

Insurance Policy Number:

Is your son allowed to walk home after camp?

Name of your son's Physician:

Physician's Phone #:

Any special medications that we should be aware of?

Additional Notes

required

$155.00

Registrant 6

This Registrant is an Adult.

This Registrant is a schoolmate (not a registered scout at this council). +$5

Please note: If the adult registering is not a parent, a Medical Form will be required for the scout and/or schoolmate registering. Download a form from scouting.org to fill out.

First Name

Last Name

Copy registration information from Registrant 1

School

Grade

Adult Contact

Relationship

Phone

Address

City

State

Zip

Sign this registrant up for escort service

	Pick up at TBD	Drop off at TBD
Monday, June 17
Tuesday, June 18
Wednesday, June 19
Thursday, June 20
Friday, June 21

I give my permission for this registrant to walk between TBD and Dracena Park, Piedmont with the Day Camp Staff.

Is your son a Reg'd Cub Scout? (yes/no)

Signing up for Schoolmates escort service? (yes/no)

Youth T-shirt size? (M/L/XL)

Are you available to help out at Camp? (yes/no)

My son is Reg'd in Pack #:

Grade he will be entering (fall 2013)?

Emergency Contact Name and #:

List any allergies we need to be aware of for your son:

Medical Insurance Company:

Insurance Policy Number:

Is your son allowed to walk home after camp?

Name of your son's Physician:

Physician's Phone #:

Any special medications that we should be aware of?

Additional Notes

» Back to Event Information