2016 STEM Camp Indiv. Info Form

User Manual: 2016-STEM-Camp-Indiv.-Info-Form

Open the PDF directly: View PDF PDF.
Page Count: 2

Download2016-STEM-Camp-Indiv.-Info-Form
Open PDF In BrowserView PDF
Pennsylvania Dutch Council

Camp Mack

Boy Scouts of America

2016 STEM CAMP

Individual Information Form
July 23-25, 2016
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 22nd, 2016 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: Fill in Scout / Pack Information:
Scout

√ Step 3: Figure Out Camp Fees

Pack #

Use this box to figure out your camp fees.

Street
City

, State _______ Zip _______

E-mail

(6STMC)

Late Fees: _____ x $25.00 = __________________________

Phone
SCOUT T-SHIRT:

Youth Camper: _____ x $175.00 = _______________

(Applies after May 6, 2016)

Grade in September:
Youth L

Adult S

Adult M

(6STMC)

Adult Camper: _____ x $105.00= ___________________

Adult L

(6STMC)

(Please circle size. Price included in camp fee if paid by May 6. See Back
for more information.)

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

√ Step 2:  YES, I’ll come to camp with my Scout!
Adult / Leader

(6STMS)

Family Night
Dinner Guests:

x $8.00 = ______________

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

(6STMM)

Street
City

Camp Photo:

, State ______ Zip

E-mail

(6STMP)

Subtract Deposit Paid: _____ X -$25.00 = ____________

Main Phone

ADULT T-SHIRT:

x $8.00 = _______________

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

Alt. Phone
Sm

Med

Lg

XL

2X

3X

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

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

TOTAL PAID TO PACK:

_______________________

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, PA Background Clearances, and 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 22, 2016.
*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

STEM Camp
Important Information – Please Read
STEM Camp is intended to be a summertime camping experience for all Cub Scouts. Scouts 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 STEM 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 STEM Camp Fee (Received at Council Service Center by May 6)
Regular STEM Camp Fee (Received at Council Service Center after May 6)
Adult Fee
Family Night Dinners (campers and children under 5 free)
Scout Den Photo
Adult T-Shirt (Optional)

$175.00
$200.00
$105.00
$ 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 6. After May 6 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 6th in order to receive the
discounted fee. NO EXCEPTIONS will be made to this policy. Payment received after May 6th 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 22, 2016 so they have time to meet the May 6th discount deadline.
> All adults attending camp must complete the PA Background Clearances and Youth Protection Training prior to
attending camp whether they are registered members of the BSA 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:

STEM 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



Source Exif Data:
File Type                       : PDF
File Type Extension             : pdf
MIME Type                       : application/pdf
PDF Version                     : 1.6
Linearized                      : Yes
Author                          : Corinne Kern
Create Date                     : 2015:12:29 15:54:15-05:00
Modify Date                     : 2015:12:29 15:58:18-05:00
Has XFA                         : No
Language                        : en-US
Tagged PDF                      : Yes
XMP Toolkit                     : Adobe XMP Core 5.2-c001 63.139439, 2010/09/27-13:37:26
Creator Tool                    : Microsoft® Word 2013
Metadata Date                   : 2015:12:29 15:58:18-05:00
Producer                        : Microsoft® Word 2013
Format                          : application/pdf
Creator                         : Corinne Kern
State                           : 1
Version                         : 1.1
Document ID                     : uuid:b69f29a5-553f-477d-9666-f2d5039078cb
Instance ID                     : uuid:5291c94c-e122-4c65-837f-99a0d289c680
Page Count                      : 2
EXIF Metadata provided by EXIF.tools

Navigation menu