Summer Camp 2022 – Camp LaNoChe

Payments will be accepted via PayPal only. The signup will direct you to PayPal after you hit submit.

We will be meeting at LCR.

Please complete this page for each scout/scouter.

Scout or Scouter's Full Name *

Scout's Date of Birth *
(mm/dd/yyyy)

Scout Patrol *
—Please choose an option—Laser SharksMooseCobraSons of LibertyKnights TemplarLeadershipAdult Leader

Your Name *

Your Phone Number *

Your Email *

Are you available to Drive? If so, please choose a direction, if not, choose NO * —Please choose an option—NOTo Camp Sunday (12th)From Camp Saturday (18th)Both Ways

What is your vehicle capacity? *

Please list the total number of seats in your vehicle including the driver. If you aren't willing to drive, please list 0.

A full physical is required to attend summer camp. The forms required include parts A, B AND C. Physicals can be obtained through your family doctor or at minimal cost at the minute clinic or similar urgent care facilities.
Medical Health Forms Up To Date? *

I know my scout's Medical Health Forms are up to date (Including Part C) and turned in.

YesNo, we will hand them in prior to the May 23rd Troop meeting

Emergency Contact (Name/Relationship/Phone) *

Please provide the full name, relationship to the scout and phone number for your primary emergency contact

Alternate Contact (Name/Relationship/Phone) *

Please Provide the full name , relationship to the scout and phone number for your alternate emergency contact

Scout-Allergies/Drug Reactions *

If none, write none

Scout-Recent Illnesses *

If none, write none

Scout-Current Prescription Drugs *

If none, write none

Informed Consent of Parent or Guardian *

My Scout(s) listed above has my (parent/guardian) permission to participate in the Troop 475 planned activity. I certify that my son is in good physical condition, and authorize the leaders to seek medical care for my son should it become necessary. To aid the leaders, should my son need over the counter medicines (Tylenol, Benadryl, Imodium AD, sunscreen &/or other topical medication, et al.) I provide my authorization. To aid with emergency medical assistance which may become necessary, I have listed above any known ALLERGIES, DRUG REACTIONS, RECENT ILLNESSES, CURRENT PRESCRIPTION DRUGS being taken, and any other information which may help a medical professional.

PARENT ACKNOWLEDGEMENT: I acknowledge that I have read and understand the above disclosure. I also acknowledge that I have read, and digitally signed, and understand the Troop 475 Annual Permission form, and that all of the information I provided is true and correct. I state that I have the authority to sign this acknowledgement, as well as the Annual Permission form. I agree my son may participate in the above event or outing, and in the planned activities, as well as in the activities normally associated with this type of event or outing (for example: packing and unpacking clothing and equipment, travelling in adult leaders’ and chaperones’ vehicles, eating, cooking, cleaning, building and extinguishing fires, setting up and taking down equipment, working on rank advancement and merit badges, and the like).

I further agree that I will drop off and pick-up my son at the indicated times and locations, unless I have made other prior arrangements with the above adult leaders. I understand that my son has duties he must perform as part of the troop, consent to his performing those duties, and agree to not interfere with his performance of those duties.

I Agree

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