PLEASE PRINT CLEARLY
Scout’s Name ________________________________________Troop Number___________
Street Address________________________________________Phone__________________
City-State/Zip_______________________________________________________________
Parent/Guardian’s Name _______________________________ Phone__________________
Please list name and phone number of a person to contact in an emergency if parent cannot be reached.
Emergency Contact____________________________________Phone__________________
The scout named above has my permission to attend Merit Badge College.
Parent/Guardian’s Signature _____________________________Date___________________
AM 1st choice ___________________________ AM 2nd choice ________________________
PM 1st choice ___________________________ PM 2nd choice ________________________
(Assume you receive your 1st choice unless notified)
List any medical condition: ____________________________________________________
Mail this form with check payable to: Buckskin Council, BSA
Merit Badge College
2829 Kanawha Blvd. E
Charleston, WV 25311
_____Class registration @ $10.00 $__________
_____Adult Lunch only @ $6.00 $__________
_____First Aid & CPR* @ $30.00 (includes lunch) $__________
*Adults and older youth ONLY (all day)
Total $__________
_____ Scoutmaster Specific Training (No Charge) All day session
_____ New Leader Essentials Training (No Charge) Morning session only
_____ Boy Scout Advancement Training (No Charge)
_____ Life to Eagle Training (No Charge)
_____ Day Camp Inspectors Training (No Charge)
(Adults wanting to each lunch with the scouts can do so for a cost of $6.00 per person)