Name:
Phone:
Age: Unit # and City:
I apply for participation in the following program:
q Project COPE
q Mountain Biking (Must include application for Cycling Merit Badge)
q BSA Lifeguard
q Kayaking BSA
q Snorkeling BSA
q Mile Swim BSA
q FROGS (New Scout Program)
Printed Name:
Signature: Date:
Address:
City: State: Zip:
Phone (W) (H)
Email: