Registration Form For Cub Scout Summer Camp (Page 2 of 2) in pdf

2017 Cub Scout Summer Camp Registra on, Page 2

Cub Scout’s Name:______________________ Pack #______ Email ___________________ Phone ________________

Required Forms for Cubs and A ending Adults

Cubs:  BSA Health form, ‐ parts A and B with immuniza on dates and two guardian signatures  Copy of Medical

Insurance Card  Firearms authoriza on (see page 1) Op onal Forms (website):  Special needs  Campership

A ending Adults:  BSA Health form ‐ parts A and B with immuniza on dates  Copy of Medical Insurance Card

 Proof of Current Youth Protec on Training (h ps://my.scou on).

See website for more informa on and to download the forms. For all day camps: submit these forms with the camp

registra on forms at the me of registra on. For resident camps,: submit these forms upon arrival at camp. The

BSA health form is required for both youth AND adults. To comply with conﬁden al informa on standards, the health

form may not be emailed.

Registra on Fees—Select Camp(s) and write in amount, total amount at bo om

For addi onal informa on about each camp go to:

Late fees added for all registra ons and payments received less than 3 weeks before the start of camp.

Cost

Total

Chenoa: 6/12‐15 (Paid on or a er 5/22, add $15)

$70

$_____

Fort Benito: 6/12‐16,

$90

$_____

includes Webelos overnight

King City: 6/12‐16 (Paid on or a er 5/22, add $20)

$80

$_____

Morgan Hill One Day Camp: 6/10 (Paid on a er 5/19, add $10)

$40

$_____

Morgan Hill 6/12‐16 (Paid on or a er 5/22, add $35)

$165

$_____

Lake Cunningham #1: 6/19‐23 (Paid on or a er 5/29, add $40)

$200

$_____

Lake Cunningham #2: 7/17‐21 (Paid on or a er 6/26, add $40)

$200

$_____

Stevens Creek #1: 7/10‐14 (Paid on or a er 6/19, add $30)

$160

$_____

Stevens Creek #2: 7/24‐28 (Paid on or a er 7/3, add $30)

$160

$_____

Toro Park: 6/19‐23 ((Paid on or a er 5/22, add $20)

$100

$_____

Towaba: 6/26‐30 (Paid on or a er 6/5, add $30)

$150

$_____

Towaba Webelos Overnight: 6/30‐7/1 (Paid on or a er 6/5, add $10)

$25

$_____

Vasona Camp: 6/26‐30 (Paid on or a er 6/5, add $30)

$165

$_____

Webelos Resident #1 6/8‐11 (Paid on or a er 5/18, add $50)

$245

$_____

Webelos Resident #2 6/15‐18 (Paid on or a er 5/25, add $50)

$245

$_____

Webelos Resident Adult Fees (Paid on or a er 5/18‐25, respec vely, add $30)

$150

$_____

Extra T‐Shirt (all camps)

 Youth small  Youth medium  Youth large  Youth X‐large

$10 (each) $_____

$_____

 AS  AM  AL  AXL  A2XL*  A3XL*  A4XL* * add an addi onal $5 for larger size

Campership Requested:

 Yes  No

Amount of Campership: $_________

Grand Total:

$_____

 Cash  Check (payable to SVMBC)

 Credit Card

Payment Informa on:

If paying by credit card:

Name on card: _______________________________________________________________________

Credit Card Number: ________ ________ ________ ________ Exp:___ / ____ Security code: ______

Signature: _____________________________________ ______________________________________

Cancella on Policy: If there are any cancella ons, please no fy the Ac vi es Director in wri ng at least 14 days prior to the

commi ed date. All refunds/transfers are subject to a 25% cancella on fee. There are no refunds 14 days before the event.

The event will be held rain or shine. No refunds due to weather.

Phone: 408-638-8300

970 West Julian Street

E-mail:

Fax: 408-280-5162

San Jose, CA 95126

Website:

Registration Form For Cub Scout Summer Camp Page 2

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