Burlington County Council Boy Scouts of America

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					 DC2012
                                                                                                                           2012 Cub Scout Camping
                                                                                                                          Burlington County Council
                                                                                                                              Boy Scouts of America

                                            DAY CAMP PARTICIPANT APPLICATION

Name (Last, First):_____________________________________________ Date of Birth: _______________
Parent/Guardian Name: ____________________________________________ Pack: _______ Den: ______

  Address: ________________________________________ City: __________________ State: ____ Zip: ________
  Home Phone: ______________________ Work Phone: ___________________ Cell Phone: ___________________
  Email Address: _______________________________________________________________________________

Age: ______ Grade: _______Rank as of September: _____________                                      T-Shirt Size: _______ (2 Provided)
             Grade Scout is Entering in Sept. 2012         Tiger, Wolf, Bear, Webelos 1                   Youth M, Youth L, Adult S, Adult M, or Adult L


  NOTE: If camper will be a Tiger Cub in September, a parent/guardian MUST attend camp with their son.

                                                         Please Circle Week(s) Attending:

    Week 1                Week 2                      Week 3                Week 4          Week 5                Week 6                     Week 7
   Go for the          Cubs Down                     Go for the           Cubs Down           Jungle             Jungle                      Jungle
      Gold               Under                           Gold                Under         Adventure           Adventure                   Adventure
   (Pine Tree)         (Pine Tree)                   (Pine Tree)          (Pine Tree)      (Pine Tree)        (Pennington)                (Smithville)
   June 25-29           July 9-13                     July 16-20           July 23-27     July 30-Aug 3         Aug 6-10                   Aug 12-16


The acceptance of your registration for Cub Scout Day Camp is contingent on the availability of sufficient capacity and adult
leadership. You will be notified on May 9, 2012, if your registration cannot be accommodated and your payment will be
refunded.

The total fee is $175.00 for registrations received by May, 2, 2012 (the early pack registration deadline) AND that meet one of
the following supervision criteria:
      The Cub Scout is attending with his pack and the pack is providing a minimum of one adult leader for every three Cub
         Scouts for the entire camp session
      The Cub Scout is not attending with his pack but is accompanied by a parent/guardian volunteer for the entire camp
         session

A pack that receives this discounted price but fails to meet the above leadership commitment at any time during the camp
session will be billed $100.00 per Cub Scout not covered by the one adult leader for every three Cub Scouts ratio.

The total fee is $275.00 for registrations that do not meet these criteria.

Every Scout in Camp must complete parts A and B of the BSA medical form.

Refund Policy:
If the registration is cancelled after May 2, 2012, but before June 1, 2012, any payments in excess of $75 will be refunded. The
$75 is non-refundable, but may be transferred to a new camper (one that registers for Cub Scout Day Camp after the
cancellation).

If the registration is cancelled after June 1, 2012, fees will not be refunded, but may be transferred to a new camper (one that
registers for Cub Scout Day Camp after the cancellation).

Rev. 01-30-2012                                                            Page 1 of 2                                                    FormID: DC2012
 DC
  2012
                                                                                                           2012 Cub Scout Camping
                                                                                                          Burlington County Council
                                                                                                              Boy Scouts of America



  All adults, including parents and guardians, that will be attending camp are required to submit a completed “2012
        Cub Scout Camping Volunteer Staff Application” and to meet the BSA registration, medical, and training
           requirements detailed on that application. All forms available on the web at cubcamp.bccbsa.org



         Allergies:       Food        Plants Medicines     Insect Bites   Other
         Please Explain Any Checked Items:
         ____________________________________________________________________________
         ____________________________________________________________________________

       Dietary Needs:
       ____________________________________________________________________________
       ____________________________________________________________________________
         Cooking is a part of the Day Camp program and we need to be aware of any and all food allergies/restrictions.
         For food allergy concerns please contact Chuck Jaxel, Camp Director at (609) 261-5850 x13.

         Activity Restrictions:            Yes          No
         Any reason to restrict activities including but not limited to: swimming, long hikes, or strenuous physical games?
         If Yes, Please Explain:
         ____________________________________________________________________________
         ____________________________________________________________________________
         Special Equipment:                Yes          No
         Any special equipment such as orthopedic or handicap devices, glasses, contacts, dentures?
         If Yes, Please Explain:
         ____________________________________________________________________________
         ____________________________________________________________________________

         General Requests:
         ____________________________________________________________________________
         ____________________________________________________________________________

              PLEASE RETURN THIS FORM WITH PAYMENT AND COMPLETED MEDICAL FORM TO:

                                                 Burlington County Council, BSA
                                                          PO Box 246,
                                                       Rancocas, NJ 08073

  All persons attending camp must submit a completed BSA Annual Health and Medical
 Record (Form 680-001, Rev. 2/2011). Only Parts A and B are required. All forms available
                           on the web at cubcamp.bccbsa.org


Rev. 01-30-2012                                              Page 2 of 2                                             FormID: DC2012

				
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