Pack Registration – Whitehouse Scouts

Pack – Scout Registration

Parent Information

First Name

Last Name

Phone/Mobile

Address

Address Line 1

Address Line 2

City

Zip Code

Additional Parents or Guardians?

Second Adult

First Name

Last Name

Adult 2 Email

Adult 2 Phone/Mobile

Third Adult

First Name

Last Name

Adult 3 Email

Adult 3 Phone/Mobile

Scout Information

How Many Scouts are you registering?

First Scout

Returning Scout or New Scout

Returning

New

First Name

Last Name

School

Scout 1 Den

Second Scout

Returning Scout or New Scout

Returning

New

First Name

Last Name

School

Scout 2 Den

Third Scout

Returning Scout or New Scout

Returning

New

First Name

Last Name

School

Scout 3 Den

I have read and agree to the Talent Release:

I hereby assign and grant to the Boy Scouts of America the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me this date by the Boy Scouts of America, and I hereby release the Boy Scouts of America from any and all liability from such use and publication.