pages day camp front 2012

Come join us at Day Camp 2014! This summer our Mad Scientist theme is Bubbling Over With
Adventure!! There will be fun and exciting things to do like shooting sports, games, crafts,
sports, making new friends and LOTS more! Look for more details to come in the future about
your District’s Day Camp. You don’t want to miss being a part of a once in a lifetime Day Camp
experience! Registration is also available online at www.1bsa.org
Arrowhead (Point Mallard)
Morgan County
District/County
Date/Time
June 9-13
8:00 am - 3:00 p.m.
Location
Arrowhead (Cullman):
Cullman County
June 16-20
5:00 p.m. - 8:30 p.m.
Cullman Fairgrounds
Birmingham
Birmingham City
June 2-6
9:00 a.m.-4:00 p.m.
Cherokee:
West Jefferson County
Camp Contact for Questions
Ashley Duffy
[email protected]
Early Bird Cut Off
CODE
19-May
907
Kerri Roberts
[email protected]
2-Jun
982
Ruffner Mountain
Deborah Hudson
[email protected]
12-May
355
June 9-13
3:00 p.m.-8:00 p.m
Farley Field-Tannehill State
Park
Paula Tucker
[email protected]
27-May
274
Choccolocco/Cheaha
Calhoun & Talladega Counties
June 9,11,13
8:00 a.m.-3:00 p.m.
Anniston Muesuem of Natural Thomas Ritch
[email protected]
History
19-May
517
Lookout Mountain
Etowah County
June 2-6
5:30 p.m.-9:00 p.m.
Noccalula Falls Campground Jenn Newton
[email protected]
12-May
609
Lookout Mountain
DeKalb County
June 16-20
4:00 p.m.-8:00 p.m.
Henager City Park
Jenny Hairell
[email protected]
27-May
574
Mountain Lake
Marshall County
June 9-13
4:00 p.m.-8:00 p.m.
Albertville Scout Hut
Angie Southers
[email protected]
19-May
782
Mountain Lake
Jackson County
June 2-6
4:00 p.m.-8:00 p.m.
Caldwell Elementary School
Angie Southers
[email protected]
12-May
782
Talakto (Cub)
Madison County
June 23-27
8:00 a.m.-2:00 p.m.
National Speleological Society Sarah Capps
[email protected]
Park
27-May
832
Talakto (Webelos)
Madison County
June 23-27
3:00 p.m.-9:00 p.m.
National Speleological Society Kaylene Brown
[email protected]
Park
27-May
832
Three Rivers (Fultondale)
Northern Jefferson County
June 2-6
4:30 p.m.-8:30 p.m.
Fultondale Elementary
Football Field
Jennifer Pierce
[email protected]
12-May
211
Three Rivers (Clear Branch)
East Jefferson/St. Clair County
June 23-27
5:00 p.m.-9:00 p.m.
Clear Branch United
Methodist Church
Tamara Brewer
[email protected]
27-May
211
Shelby (Cub)
Shelby County
June 2-6
8:00 a.m.-2:00 p.m.
Oak Mountain State Park
Mike Rocchio
[email protected]
24-Apr
256
Shelby (Webelos)
Shelby County
June 2-6
3:00 p.m.-8:30 p.m.
Oak Mountain State Park
Greg McGill
[email protected]
24-Apr
256
Vulcan (Cub)
Southern Jefferson County
June 16-20
8:30 a.m.-3:30 p.m.
Oak Mountain State Park
Michael Wells
[email protected]
19-May
233
Vulcan (Webelos 2)
Southern Jefferson County
June 16-20
4:30 p.m.-8:30 p.m.
Oak Mountain State Park
David Philpot
[email protected]
19-May
233
Westmoreland
Lauderdale County
June 9-13
4:00 p.m.-9:00 p.m.
Laurel Rickard
[email protected]
19-May
957
REGULAR COST: $100
EARLY BIRD COST: $75
LATE COST :$125 (Week of)
Point Mallard Park
Camp Westmoreland
To qualify for the early bird discount ALL fees MUST be
in to a Council Service Center by the listed “CUT OFF” date.
www.1bsa.org
Greater Alabama Council
516 Liberty Parkway-Birmingham, Alabama 35242-Phone: 205-970-0251-Fax: 205-970-0349
DAY CAMP REGISTRATION FORM
DAYCAMP 3 digit # on Flier: # ________ Location ____________________________________ Date ________________
Rank In Fall 2014
____________
Grade In Fall 2014
_____________
CUB SCOUT NAME _______________________________________________________________ DISTRICT ______________________
ADDRESS _______________________________________________________________________ AGE __________ PACK # ________
CITY ____________________________________________________ ZIP ____________ HOME PHONE __________________________
PARENT/GUARDIANS NAME _______________________________________________________________________________________
ADDRESS _______________________________________________________________ CELL PHONE ___________________________
CITY ____________________________________________________ ZIP ____________ WORK PHONE __________________________
PARENT'S EMAIL ADDRESS ________________________________________________________________________________________
YES, I WILL WORK AS A VOLUNTEER. Please call me at the following numbers
HOME. _________________________ WORK __________________________CELL __________________________
DAYS I CAN WORK: MON _____ TUES _____ WED _____ THURS _____ FRI ______ ALL WEEK _______________
"5-DAY VOLUNTEER'S DISCOUNT” is for day camp leaders approved by the Camp Director, who work all week:
$30.00 discount for first child and $20.00 discount for second child. Can be combined only with Early Bird discount. Full fees must be paid up
front. All VOLUNTEER discounts will be applied after day camp is completed.!
CUB SCOUT CONTACT INFORMATION (From Health Form Part B)
List other adults authorized to present your child for medical treatment or transport to and from Camp.
1._______________________________________________________________________ Cell Phone _____________________________
2._______________________________________________________________________ Cell Phone _____________________________
3._______________________________________________________________________ Cell Phone _____________________________
Adults NOT authorized to take youth to and from Camp:
Name _________________________________________________ Name ___________________________________________________
PARENTS/GUARDIANS - FILL OUT THE T-SHIRT SIZE YOUR CHILD WILL MOST LIKELY WEAR!
YOUTH T-SHIRT SIZE
Y/S ____ YIM ____Y/L ____ A/SM ____ A/M ____ A/LG ____ A/XLG ____
ADULT T-SHIRT SIZE (for core staff and week long walking den leaders)
ASM ____ AM ____ ALG ____ XLG ____ XXLG ____ 3X ____
EXTRA SHIRTS FOR SALE- $10.00 EACH
Y/S ____ Y/M ____Y/L ____ A/SM ____ A/M____ A/LG. ____ A/XLG ____ XXLG ____ 3X ____
#____ x $10.00 = _________
SUPPLEMENTAL HEALTH INFORMATION
Health Officer May Administer:
Benadryl
Tylenol (Amount) ______
Advil (Amount ) _____ How Often __________
If your child will require regular medication at camp it is to be turned into the Health Officer each morning in its
original container with its instructions. Exceptions to this include certain medications, such as inhalers or
EpiPens that need to be with the child.
List any medications to be taken at camp:
Medication ___________________________________________________________________
Copies of Annual BSA Health and
Medical Record Part A and Part B
must be submitted along with this
registration form.
FOR COUNCIL USE ONLY:
Health Form Received:
Date _________________
Signature ________________________________________________Date ________________
Registration Fee
Early Bird Discount
T -Shirt Purchase
Total Amount Due
$100
- ____
+ ____
= ____
I am paying by (Check One)
Cash
Check
Visa
MasterCard
Discover
CARD# _____________________________________________________ EXP DATE ______________
NAME ON CARD ______________________________________________________________________
SIGNATURE (Required) _________________________________________________________________
Registration fee is $100. An Early Bird discount of $25 applies if payment is received by the date specified for this camp. $125 if recived week of.
"No-shows" will not be granted refunds. Refunds, less a 20% service fee, will be considered for sickness, death in the family or a school related issue.
Mail, deliver or fax completed registration form and health form with payment to:
Greater Alabama Council, BSA
P.O. Box 43307
Birmingham, AL 35243
or by fax 205-970-0349
Huntsville Service Center
2211 Drake Ave SW,
Huntsville, AL 35805
or by fax 256-883-2193