Cub N Pal

Spring Cub N Pal Registration
May 14-16, 2010

Scouts and parents will spend two nights and days with many other families from North Texas.

Boy's Name

Pack #

Grade:

Adult Partner's Name

Relationship

Home Phone #

Bus/Cell Phone #

Address

City, State, Zip

CONTACT IN CASE OF EMERGENCY

Name

Relationship

Phone #

Alt Phone #

Family Physician

Physician's Phone #

Please fill out Medical History COMPLETELY

Please check ALL that apply and explain below regarding medications needed or physical limitations due to any medical conditions, attach additional information if needed.

Cub Scout/Child:

Adult Partner:

Please list detailed medical information here, including special dietary needs, allergies and medications.

30% of the registration fees for in-council youth and Scouters has been paid through
a grant from The Priddy Foundation.

Early Registration is until Friday April 23, 2010

In-Council Registration fee: $35.00 for Cub Scout and 1 adult partner.
Additional Cub Scouts: add $10.00 each
Additional NON-SCOUT child or adult: add $15.00 for each

Out of Council Registration fee: 50.00 per camper & adult partner
Same fees apply for additional participants.

Late Registration April 24th through May 7, 2010

NO REGISTRATION WILL BE TAKEN AFTER May 7, 2010

Late fees will be $70.00 per Cub Scout and Adult,
$20.00 per extra Cub Scout and $30.00 for each extra child or adult.
Registering late will not guarantee a patch or t-shirt

Cub N Pal Registration - $35/pair

Additional Scouts - $10 each

Additional non-Scouts - $15 each

List additional persons here: This is requested so we can charge the correct fees. Please make sure you complete a Health & Medical form for each additional child or adult.

By submitting credit card information below, you are agreeing and accepting the following terms and the amount checked above:

Parent Authorization: This health history is correct as far as I know and the persons herein described have permission to engage in all prescribed activities, except as noted by the physicians and/or myself. I will register any medication taken by my son(s) and /or his adult partner with the health official at the camp. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp health official and/or leader in charge to secure proper hospitalization, anesthesia, medications, and/or surgery for my son and the adult partner.

I hereby consent to the use of voice, photograph, and/or video in the news coverage, moviemaking, or similar projects approved by the Boy Scouts of America for all persons named on this form.

Card Type

Card #

Expiration Date

Name as it appears on card

If you would like a confirmation email, please provide email.


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