2022-'23 BPSA Scouting Membership Application

2022-'23 BPSA Scouting Membership Application

2022-2023
New or Returning Member?*
Type a question*

Explorer Troop (ages 11-14)Sr. Explorer Troop (ages 15-17)Rover Crew (ages 17+)Adult Leadership (in a section)
Full Name of Youth*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Current age of Applicant*
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent & Guardian Names *
(all names of those authorized to pickup or drop off the above youth)
Email Communication Address(es)*
Please use email addresses which you monitor regularly as this is a key method of communication and sharing of information regarding our group activities.
PHOTO CONSENT*
I hereby grant the BPSA permission to use my and/or my child's image in all publications, both print and electronic, and display on the Association's websites. I also give permission for the BPSA to give this image to a reputable third party, when requested, for both print and electronic publications.
PHYSICALLY FIT*
I certify that my son/daughter is in good health and physical condition.
MEDICAL, DIETARY, FAMILY CIRCUMSTANCES, CUSTODY ISSUES, or RELIGIOUS REQUIREMENTS. If yes, then the Scoutmaster will contact you to discuss.*

YESNO

APPLICANT MEDICAL INFORMATION

Your child’s health is important to us and this will help us if there is anything we need to know about them.
Name*

First NameLast Name
PRIMARY CONTACT*

First NameLast Name
PRIMARY CONTACT #*

Area CodePhone Number
SECONDARY CONTACT

First NameLast Name
SECONDARY CONTACT #

Area CodePhone Number
EMERGENCY CONTACT*

First NameLast Name
EMERGENCY CONTACT #*

Area CodePhone Number
Email
example@example.com

APPLICANT MEDICAL INFORMATION