Pack Registration

Primary Parent/Guardian Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home/Mobile Phone *

Email *

Confirm Email

The best way to reach me is by: *

Phone
Email
Other

Secondary Parent/Guardian Name *

First

Last

Emergency Contact *

First

Last

Emergency Contact Phone *

Alternate Emergency Contact

First

Last

Alternate Emergency Contact Phone

Scout Name *

First

Last

Gender *

Date of Birth *

Grade *

Does this scout reside at the same address as Parent/Guardian? *

Major and Minor Allergies (enter None if none apply)

Medications (enter None if none apply)

Diagnosis (if any)

Equipment/Assistive Technology (if any)

Additional medical issues (if any)

Overall health *

Important information for leaders to know

Scouts Strengths *

Scouts Challenges *

How does the scout learn best? *

Things to avoid *

Additional information

Do you have additional scouts to register? *

Do you have additional children not in Cub Scouts? *

Fundraiser Understanding: In order to “Help the Pack Go,” our family understands that we need to participate in the fall and spring fundraisers or pay the opt out amount set annually by the Board. These funds are vital to helping run a successful program each year and assist in keeping annual dues low. (Note: fundraising does not apply to Lion scouts.) *

I understand and acknowledge

Media Release Agreement: I hereby agree and consent to the use of any photograph, voice recording, or videotape of the child (minor) named hereafter for promotional and/or publicity purposes on behalf of the Scouts, BSA and its subsidiary organizations, including but not limited to use in newspapers, broadcast media, websites, and so forth. All rights and interest in the finished product are relinquished and all rights to payment or compensation are waived. *

I understand and acknowledge

The Scout Oath

The Scout Law