Text Box: Spring Fellowship Registration Form Please complete this form and the lodge medical form on the other side and return them to the scout office. The lodge will NOT keep medical forms all year. A new form will need to be filled out for each event. Name: ___________________________________________ Unit#: _______________ Address: _________________________________________________________________ City State & Zip Code: _____________________________________________________ Chapter: ________________________________ Home Phone: ____________________ Work Phone: _______________ Email: ______________ Date of Birth: ____________ Circle One: Youth Adult q The Cost for the Weekend $20.00 q Supper Only with Brotherhood $5.00 q 2007 Dues $10.00 Required Parental Permission Form I hereby authorize my above named Scout to attend and give full permission in this Fellowship Weekend. In the event of illness or accident in the course of such activity, I request that measures be instituted without delay as medical personnel dictates. Print Parent name: _______________________________ Phone: ________________ Date: _______________ ______________________ _________________________ Parent/Guardian must sign if Scout Scout's Signature Activity # 852 Is under 18 years old
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Be sure to go to the Forms page to access the Lodge Medical Form.  This MUST be submitted with the above form!