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 Name Last Name
Date of Birth *

Month Day Year
Date
Current age of Applicant *
Address *

Street Address

Street Address Line 2

City Province

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. *

YES NO

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 Name Last Name
PRIMARY CONTACT *

First Name Last Name
PRIMARY CONTACT # *

Area Code Phone Number
SECONDARY CONTACT

First Name Last Name
SECONDARY CONTACT #

Area Code Phone Number
EMERGENCY CONTACT *

First Name Last Name
EMERGENCY CONTACT # *

Area Code Phone Number
Email
example@example.com

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APPLICANT MEDICAL INFORMATION