Golden Arrow Cub Scout Twilight Camp 2008

Online Den Chief Registration

Use this form to register a Den Chief for Twilight Camp.

Please complete this entire form, including the immunization dates, and click the "submit" button at the bottom.

After you submit this form, as a final step, you will be asked to
print the confirmation page, sign it and mail it to the registrar.
Your registration is not complete until the signed hard copy is received.

Items marked with a * are required.

First Name* Last Name*
Age*
BSA Counsel (e.g. Sam Houston)*
District (e.g. Golden Arrow)* Troop Number*
Parent/Guardian Name*
Email Address:*
Home Street Address*
City* State* Zip (+4)*
Home Phone* Daytime Phone Cell Phone
How many previous years have helped at Twilight Camp?
The BSA requires a quota of CPR and Red Cross certified camp staff. Please help us by selecting "YES" if you have the following certifications and provide the agency and expiration date.
Red Cross Certification? Agency Expiration Date
CPR Certification Agency Expiration Date
Please select the Camp Dates you will attend.
Den Chiefs must be in attendance ALL DAY, EVERYDAY.
Week 1: June 2 – 6, 2008, 5:30 pm – 9:00 pm
Week 2: June 9 – 13, 2008, 5:30 pm – 9:00 pm
T-Shirt Size: Please check appropriate size. This will be your camp uniform, and it must be worn EVERY night. When ordering your t-shirt, keep in mind that the t-shirts do shrink and tend to run small.
T-Shirt Size
All Dens will be formed by the Camp Registration Staff. Volunteers will be placed where needed. That may not necessarily be with the scouts that you volunteered with. However, whenever possible, the staff will try to honor the request. Please list the ONE scout with whom you would like to be placed with and his rank, Cub or Webelos.
Scout Name Rank

Youth Health History
Physician* Physician Phone*
In case of an emergency, call these people in this order:
Name 1* Phone 1* Relation*
Name 2 Phone 2 Relation
Name 3 Phone 3 Relation
Problems with (Please select "YES" for any that apply):*
Asthma Fainting spells Convulsions
Heart trouble Diabetes Seizures
Bleeding Disorders
Allergy to any medication, food, plants, animals, or insect toxins
Any condition that may require special car, medication, or diet
If you selected "YES" to any of the above, please explain:
Have difficulty with (Please select "YES" for any that apply):*
Eyes, ear, nose, or throat Digestion Lungs
Any restrictions of activity for medical reasons?
If you selected "YES" to any of the above, please explain:

Immunizations:*

The Texas Department of Health requires the camp to obtain an actual DATE for each inoculation below.

If any inoculation date is missing, the "submit" button below will reject this form.

If your records do not show an exact date, please enter the closest calendar date.
Date of last inoculation
MM/DD/YYYY		   Date of last inoculation
MM/DD/YYYY		   Date of last inoculation
MM/DD/YYYY
Tetanus* Measles* Pertussis*
Diphtheria* Mumps* Hib*
Polio* Rubella*
Allergy or reaction to any of the following:*
Medication: If YES, explain:
Bee stings, insect bites, or plants: If YES, explain:
Food: If YES, explain:
Other: If YES, explain:
Any condition requiring medication?*
If YES, name of Medication(s):
Will it be necessary to administer this medication while at Twilight Camp?
If YES to the above, please explain:
Is your child on, or has he recently been on the medication
Ritalin, or other medications for ADHD?*
Is he taking a summer break from this medication?
Comments, Questions or Additional Information:
Click the Submit Button to send your information.
Click the Reset Button to clear the form.