Fillable Atlanta Area Council - Nylt Application Checklist printable pdf download

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Online Application Checklist

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NYLT

Atlanta Area Council, Boy Scouts of America

1800 Circle 75 Parkway, SE

Atlanta, GA 30339

Please use this form to complete your online application. Staple all items to this sheet and mail or deliver all materials to the

Volunteer Service Center at the address above or follow the instructions below to email them to NYLT. Units may group

multiple packets together with a single check.

Troop

_______________________________

_________

Please print

Scout’s Name:

Unit Type ___________ Unit #

District: ___________________

Please read, sign, and attach the Participant and Parental NYLT Contract (page 3)

Out of Atlanta Area Council

Please attach one COMPLETE

copy

of your BSA Annual Health and Medical Form #680-001_ABC or a BSA High Adventure

Health and Medical record that is dated no earlier than 12 months from the end of the course attending.

Online Medical Form

or go to

BSA Forms

for the latest form. (See below for Medical Form Check List)

30TU

U30 T

3 0T U

U30T

This Scout will need the following accommodations at NYLT for medical, physical, behavioral, or religious reasons:

This Scout will have and may use the following medications:

(Use addition page(s) if necessary)

My child named above has my permission to attend the AAC NYLT program.

Parent/Guardian Signature:

Printed Name: _________________________________________________ Date:

Daytime Telephone No

Nighttime Telephone No.

Parent’s Email

The course fee is $225. Payment may be made by attaching:

Check payable to Atlanta Area Council - NYLT (Memo: Acct. 1.6801.054.20). Check No.

Credit Card Visa/MC/AMX/Discover

Name on Card

Number

Expiration

Signature

Camperships:

There are a limited number of need based camperships available for up to 50% of the course fee. NYLT Campership Applications are

available from your District Executive who must also sign and submit the application. Scouts needing this assistance to be able to attend the course should

enclose a balance payment of $225 minus amount they are requesting. This payment is fully refundable should campership funds not be available.

Campership applications should be submitted as soon as possible and no later than April 15

for Spring Sessions, no later than October 15

for the Fall Session,

and no later than November 15

for the Winter Session.

I will be requesting a campership in the amount of $_________ (not more than $112.50).

Refund Policy:

Course fees are fully refundable 30 days or more before the start of Session 1 (for Sessions 1-3) and subsequent sessions. A 50%

cancellation penalty will apply to cancellations from 29 to 15 days before the start of Session 1 (for Sessions 1-3) and subsequent

sessions. No refunds will be given for cancellations received after 15 days before the start of each NYLT Session. Penalties may be

waived or modified at the Course Director’s (not the Scoutmaster’s) discretion in exceptional circumstances (contact the Course Director at

3 0 T

3 0T

Delivery Instructions:

These forms may be emailed directly to the Program Center for processing:

mailto:docarr@bsamail.org?subject=NYLT Application for

30 T

[you can enter your Scout’s name on the subject line of your email program] Please cc:

mailto:registrar@aacnylt.org?subject=NYLT

3 0T

Application for

[you can enter your Scout’s name on the subject line of your email program] . Medical Forms may be emailed directly to

3 0T

mailto:registrar@aacnylt.org?subject=Medical Form for

[you can enter your Scout’s name on the subject line of your email program] for

3 0 T

processing. Parts A&B may be emailed now and Part C must be received as soon as possible, but in no event after the second day of the

course being attended.

Contact the Program Center at 770-989-8820 or email the NYLT registrar for instructions or if you have questions.

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HO-NYLT-Application-Checklist-2014.doc

Version: 2014-09-17

Atlanta Area Council - Nylt Application Checklist

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