Provisional Camper Application Form printable pdf download

Provisional Camper Application

(This form to be used by Scouts who wish to attend camp at some time other than the assigned time of their own Scout Troop)

Fee for Provisional Scout $240

Troop Number:_______ District:_______________ Council: __________________________________

Full Legal Name of Scout: ______________________________________________________________

Address: ___________________________________________________________________________

City: __________________________________

State: _________________

Zip: ______________

Phone Number: (_________) _________ - ________ Date of Birth: _________/_________/_______

Rank: _____________ Prior Years at Boxwell: _____________ Parents Email: ____________________

Emergency Information:

Parent/Guardian Name: _______________________________________________________________

Daytime Phone: (_________) _________ - _________ Evening Phone: (________) _______ - ______

Other Emergency Contacts:

Name: _____________________________________ Relationship: ____________________________

Daytime Phone: (_________) _________ - _________ Evening Phone: (________) _______ - ______

Name: _____________________________________ Relationship: ____________________________

Daytime Phone: (_______) _________ - ________ Evening Phone: (_______) _________ - ________

Other Information

Choose your Week of Attendance

Week 1, June 12 – 18

Week 2, June 19-25

Week 3, June 26-July 2

Week 4, July 3-9

Week 5, July 10-16

Merit Badge Selections -

Merit Badge Schedule page or

9:00 AM _________________________

2:00 PM _________________________

10:00 AM _________________________

3:00 PM _________________________

11:00 AM _________________________

4:00 PM _________________________

Alternate class choices: _________________________

_________________________

Approvals

Parent/Guardian Signature: _______________________________________Date: ________________

Scoutmaster Signature: __________________________________________Date: ________________

Instructions:

1. Complete all sections.

2. Attach the appropriate merit badge fees and return to the Council Service Center ($100 deposit)

3. Bring Medical Form to camp check in. (Annual Health and Medical Record)

Mail application to: Middle Tennessee Council, BSA, P.O. Box 150409, Nashville, TN 37215

- 49 -

Provisional Camper Application Form

Related Articles

Related forms

Related Categories