Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Parent Phone #1 *

(###)

###

####

Parent Phone #2

(###)

###

####

Emergency Contact Phone *

(###)

###

####

Does your child have any allergies? *

Please check all that apply

Food

Medicine

Plants

Bites/Stings

Other

None

Will your child require medication at camp? *

All medication needs to be provided to the camp medic with instructions. No scout is allowed to have any medication (prescription or non-prescription) in their presence.

Yes

No

I have read and agree to the Parent Code of Conduct for Scouting Events *

Yes

I have read and agree to the Scout Code of Conduct for Scouting Activities *

Yes