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Troop Number: 
Council: 
State: 
Attending Week Of: 
 
 
Primary Contact First Name: 
Primary Contact Last Name: 
Primary Contact Gender: 
Primary Contact Email: 
Primary Contact Phone: 
Signup Username: 
Signup Password: 
Confirm Signup Password: 
 
 
Days Attending (if any):SundayMondayTuesdayWednesdayThursdayFriday 
If you will be attending camp please provide the following information if applicable. 
Special Needs:Food AllergiesDietary ConcernsOther Medical Needs 
 Uses WheelchairOther Disabilities 
 Additional notes: