Merit Badge Counselor Information Form - Boy Scouts Of America printable pdf download

Boy Scouts of America

MERIT BADGE COUNSELOR INFORMATION

(Please print)

Name_______________________________________ Birth Date _________

Business Phone (____) ________________________

Address________________________________________________________

Home Phone (____)_________________________

City_____________________________ State_____ Zip Code ___________

E-mail Address _____________________________

To qualify as a merit badge counselor, you must:

As a merit badge counselor, I agree to:

•

Be at least 18 years old

Follow the requirements of the merit badge, making no deletions

•

or additions, ensuring that the advancement standards are fair and

Be proficient in the merit badge subject by vocation

uniform for all Scouts.

or avocation.

•

Have another Scout, parent or guardian, relative or friend present

Be able to work with Scout-age boys

•

at all instructional sessions.

Be registered with the Boy Scouts of America as a

•

Renew my registration annually if I plan to continue as a merit

merit badge counselor (position code 42)

badge counselor (position code 42) as required by your district.

Is the merit badge subject related to your work? If the merit badge subject is a hobby, do you have a "working knowledge" of the

requirements? Do you have any special training or other qualifications for the merit badge subject? Explain your qualifications

below:

(For the Swimming and Lifesaving merit badges, current Safe Swim Defense and CPR certification is required. For the Rowing, Canoeing, Small-boat

Sailing, Motorboating and Waterskiing merit badges, current Safety Afloat and CPR certification is required. To serve as a counselor for the Rifle or Shotgun Shooting

merit badge, you must have the relevant NRA certification. First Aid Training is highly recommended for aquatics and shooting merit badge counselors. Additional

Please attach copies of all relevant

council-approved training may be required for other merit badge subjects (for example Whitewater merit badge).

certifications. All required certifications must be maintained and copies submitted as they are renewed.

List merit badge subjects here

Qualifications (Attach additional pages if needed)

There is no fee for becoming a merit badge counselor. You need to submit this form and a BSA Adult Leader Application upon initial

registration.

CHECK APPROPRIATE BOX OR BOXES:

I wish to work with all units

I wish to work only with ________________________________________

(Unit Number)

I am currently registered in ________________ of __________________ District as a _______________________________

(Unit Type and number)

(Scouting position)

I am not currently registered. My Adult Registration form is attached.

Note: The BSA Adult Application must be attached if you are registering as a merit badge counselor (position code 42) for the

first time regardless of any other registrations in any other position or if your registration as a counselor is not current.

Applicant Signature____________________________________________________________ Date_____________________

Council approval by____________________________________________________________ Date _____________________

Revised July 2004

Merit Badge Counselor Information Form - Boy Scouts Of America

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