BUCKEYE COUNCIL, INC.
BOY SCOUTS OF AMERICA
SPL-2-B REGISTRATION FORM
#5
(PLEASE COMPLETE AS MUCH INFORMATION AS POSSIBLE)
Please print
HOME TROOP ________
SPL NAME ____________________________________________________________
WEEK _______________
ADDRESS _____________________________________________________________
HOST TROOP ________
CITY, STATE, ZIP ______________________________________________________
WEEK _______________
HOME PHONE _________________________________________________________
EMAIL ________________________________________________________________
MOTHER’S NAME ______________________________________________ WORK PHONE ___________________
FATHER’S NAME _______________________________________________ WORK PHONE ___________________
HOME TROOP SCOUTMASTER ___________________________________ HOME PHONE ___________________
ADDRESS ______________________________________________________ WORK PHONE ___________________
CITY _________________________________________ STATE _________ ZIP CODE _______________________
PRESENT RANK OF SPL-2-B _____________________________________
YEAR OF PIPESTONE THAT SPL-2-B PRESENTLY HOLDS ___________
st
AMOUNT OF PAYMENT FOR 1
WEEK
$_________________
RECEIPT # ___________________________________ PAID ON ___________________________________________
PARENT’S SIGNATURE ____________________________________________________ DATE _________________
HOME TROOP SCOUTMASTER’S SIGNATURE ________________________________ DATE ________________
nd
(There is no charge for the 2
week of camp for the SPL-2-B)
CAMP USE ONLY
HOST TROOP SCOUTMASTER _____________________________________________ TROOP NO. ____________
CAMP DIRECTOR’S APPROVAL _________________________________________ DATE ____________________
HEALTH OFFICER NOTES:
C:\Users\Tscarps\Desktop\Website Flyers\#5 - SPL-2-B registration.doc