Request For Camp Form

Longhorn Council BSA

Request for Longhorn Council Day Camp Campership

50% OF CAMP FEE MUST BE SUBMITTED WITH THIS APPLICATION FOR APPROVAL BY MAY 21st.

Registrations for Cub Scout needing Campership may not be done with the online system.

Pack No.__________ District_________________ Cubmaster______________________ Date Joined Unit_____________

Name____________________________________________________ Age______ Rank_____________________

Address_______________________________________________________________________________________

City________________________________________________ State______ Zip_________ Phone______________

Camp__________________________________________________ Dates for Camp__________________________

Total Value of Campership Request $___________. Maximum award is 50% of Camp Fee (Day Camp only).

Reasons for Campership Request (be specific): _______________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Describe in detail EACH Unit Fund Raiser and the Cub’s Participation during Past Year:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Required Signatures

UNIT CERTIFICATION:

I certify on behalf of the Pack Committee that the applicant cannot afford to attend camp without a campership and that Troop funds and projects have

been considered and are not available to be provided to the applicant.

___________________________________

______ ___________________

______________________

Pack Committee Chairman or Cub Master

Date

Contact Phone

Contact email

CHARTERING ORGANIZATION CERTIFICATION:

I certify on behalf of the Chartering Organization that the applicant cannot afford to attend camp without a campership and that Pack funds and projects

have been considered and are not available to be provided to the applicant.

___________________________________

________________________

______________________

Head of Chartered Organization or

Chartered Organization Name

Date

Chartered Organization Representative

________________________

______________________

Contact Phone

Contact email

DISTRICT CERTIFICATION:

I certify on behalf of the District Committee that the applicant cannot afford to attend camp without a campership and that Pack funds and projects have

been considered and are not available to be provided to the applicant.

___________________________________

________________________

______________________

District Committee Chairman or representative

Contact Phone

Contact email

___________________________________

________________________

______________________

District Camping Chairman or representative

Contact Phone

Contact email

COUNCIL CERTIFICATION:

___________________________ ___________

___________________________ __________

Council Camping Chairman

Date

Scout Executive or representative Date

50% OF CAMP FEE MUST BE SUBMITTED WITH THIS APPLICATION FOR APPROVAL

Receipt #________________ Date_______________ Paid______________________________________________