2015 Cub Res Indv. Info Form

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Pennsylvania Dutch Council

Camp Mack

Boy Scouts of America

2015 CUB SCOUT RESIDENT CAMP
Individual Information Form

“Medieval Adventure”
Complete this form and return it with a copy of your completed health form WITH PAYMENT
FOR ALL FEES LISTED to YOUR PACK before or by April 24th, 2015 so your pack can turn it in on time and
avoid a LATE FEE! Read this form completely (front and back) before beginning!

√ Step 1. Indicate the session you wish to attend:





Cub Res. Session 1
Cub Res. Session 2

June 19-21

√ Step 4: Figure Out Camp Fees

June 26-28

Use this box to figure out your camp fees.
Cub Res Camper: _____ x $170.00 = _______________

√ Step 2: Fill in Scout / Pack Information:
Scout

(6RESC)

Late Fees: _____ x $25.00 = __________________________

Pack #

(Applies after May 8, 2015)

Street

(6RESC)

Adult Camper: _____ x $100.00= ___________________

City

(6RESC)

, State _______ Zip ________

Adult Shirt (opt.): _____ x $12.00= ________________

E-mail

(6RESS)

Phone

Grade in September:

SCOUT T-SHIRT: Youth L

Adult S

Adult M

Family Night
Dinner Guests:

Adult L

x $8.00 = ______________

(all campers & all guests age 5 & under eat free)

(Please check size. Price included in camp fee if paid by May 8. See Back
for more information.)

(6RESM)

√ Step 3:  YES, I’ll come to camp with my scout!

Camp Photo:

Adult / Leader

Subtract Deposit Paid: _____ X -$25.00 = ____________

(6RESP)

(If you previously paid a deposit subtract it here.
Deposits are Non-Refundable)

Street
City

, State ______ Zip

Subtract Campership/Popcorn Prize: -______________
(Must attach copy of Campership or Popcorn Prize
letter from PA Dutch Council to receive credit)

E-mail
Main Phone

ADULT T-SHIRT:

x $8.00 = _______________

TOTAL PAID TO PACK:

Alt. Phone
Sm

Med

Lg

XL

2X

3X

(Optional: purchase price $12.00 is not included in adult camper fee)

_______________________

PA Dutch Council does not maintain information on
individual “Scout Accounts” nor can it give credit for
funds in these accounts. If your pack uses “Scout
Accounts” use of those funds for summer camp is
between you and your Pack.

√ FINAL STEP: Complete the following additional required forms: Annual BSA Health and Medical
Record (Parts A & B only) for every camper (scout & adult) listed above, BMX Pump Track Hold
Harmless Form, Camp Mack Special Dietary Needs Form, Youth Protection Training for each adult.
Once complete, attach a COPY of these forms to this registration form. Turn your packet and a
check made out to your Pack into your pack by April 24, 2015.
*SEE OTHER SIDE FOR IMPORTANT INFORMATION*

Pennsylvania Dutch Council 630 Janet Ave. Suite B-114 Lancaster, PA 17601

717-394-4063

www.padutchbsa.org

Pennsylvania Dutch Council

Camp Mack

Boy Scouts of America

Cub Scout Resident Camp
Important Information – Please Read
Cub Scout Resident Camp is intended to be a summertime camping experience for Wolf and Bear Dens. Wolf and
Bear Dens are encouraged to make plans to attend camp, with adults attending with their sons. It is the
responsibility of the Pack to secure sufficient adults following the guidelines in the Camp Adult Guide and on the
Camp website www.padutchbsa.org/camping/mack.
INDIVIDUAL REGISTRATION: If you plan on attending Cub Scout Resident Camp and no one else from your Pack
is planning on attending the same session, you can still come! In this case, an adult family member (21 years of
age or older) must accompany your Cub Scout. To register as an individual, fill out this form and send it directly to
the PA Dutch Council Service Center with payment and all required attachments.

FEES:

Discount Cub Res. Camp Fee (Received at Council Service Center by May 8)
Regular Cub Res. Camp Fee (Received at Council Service Center after May 8)
Adult Fee
Family Night Dinners (campers and children under 5 free)
Scout Den Photo
Adult T-Shirt (Optional)

$170.00
$195.00
$100.00
$ 8.00
$ 8.00
$ 12.00

Camper and adult fees include all meals, program materials, and a camp patch. Youth camper fees also include a
water bottle. Youth t-shirts are included in the camper fee if paid by May 8. After May 8 youth t-shirts will be
available at the camp trading post while supplies last. Adults may want to purchase a T-shirt. The Trading Post will
be open daily with cold drinks, snacks, Camp Mack mementos, etc. for purchase.
> Make your check payable to your Pack to cover all fees shown above.
> Summer camp fees are due in the Council Service Center NO LATER than May 8th in order to receive the
discounted fee. NO EXCEPTIONS will be made to this policy. Payment received after May 8th must be for the
Regular Fee listed above and will not include a youth t-shirt. Be sure you submit your paperwork and check to
your Pack by April 24, 2015 so they have time to meet the May 8th discount deadline.
> It is encourage that all adults attending camp complete Youth Protection Training whether they are registered or
not.
> REFUNDS: The PA Dutch Council Camp Refund Policy will be strictly followed. A copy of this policy can be
found in the Camp Adult Guide and on the camp website www.padutchbsa.org/camping/mack.
> MEDICAL FORMS are required for every youth and adult camper. At the end of your camp session the
medical forms will be returned. Be sure to make copies before you come to camp. Keep the original at home
in a safe place to use again. Copies cannot be made at camp. MEDICAL FORMS ARE REQUIRED FOR
EVERYONE AS FOLLOWS:

Cub Resident Camp Medical Form: Annual BSA Health and Medical Record Parts A &
B plus the Camp Mack Special Dietary Needs Form
CHECK OUT THE COUNCIL WEBSITE: www.padutchbsa.org for more information on
other camping opportunities.

Pennsylvania Dutch Council 630 Janet Ave. Suite B-114 Lancaster, PA 17601

717-394-4063

www.padutchbsa.org



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