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CAMP O-KI-HI 2015

ADULT STAFF APPLICATION

UNIT / FIRST NAME / LAST NAME
HOME PHONE / WORK PHONE (OPT) / CELL PHONE
ADDRESS
CITY / ZIP CODE
E-MAIL ADDRESS (type or print clearly)
We use email heavily for correspondence. Please use an email address that you check regularly.
EMERGENCY CONTACT/RELATIONSHIP / CONTACT PHONE NUMBER(S)
VEHICLE YEAR/MAKE/MODEL / LICENSE PLATE # / NO. OF SEAT BELTS
VEHICLE OWNER’S NAME / DRIVER’S LICENSE NUMBER
Please check if you are willing to drive scouts to activities during the camp session. If checked, vehicle insurance information needs to be provided prior to camp session.
CAMP SESSION: SAT, JUNE 20 – SUN, JUNE 28, 2015
(NOTE: Saturday, June 20th is mandatory staff training.) / SHIRT SIZE (ADULT SIZES):
S / M / L / XL XXL / XXXL / AGE:
As of June 20, 2015
18 - 21
Over 21
BSA MEMBERSHIP
You must be registered with the BSA to attend Camp O-Ki-Hi. If already registered, complete the following:
I am currently registered in # ______in the Council, BSA.
(Pack, Troop, Crew, Post) (Number)
Current Scouting Position: ______
If not already registered with a troop or crew, are you willing to be registered with BSA Crew 225? Yes No
All Adult Staff members must have at least one staff shirt. Staff shirts are available for $15.00 each.
Payment of $90.00 for meals is due with this application form.
Fee included:
Camp Meal Fee @ $90.00 / = / $
Staff Shirt @ $15.00 each x / (number of shirts ) / = / $
BSA Registration Fee @ $14.00
(if not currently registered with the BSA) / ($2.00/month for 7 months) / = / $
TOTAL ENCLOSED / = / $

Make checks payable to “Beaver Valley Boy Scouts”

Cindy Tashiro-Cramer, Registrar v 5056 Mertola Dr., El Dorado Hills, CA 95762

Phone: (916) 939-2275 v email:

NAME:
TRAINING CERTIFICATIONS - Please check all that apply:
CPR (American Heart, Red Cross) Exp Date:
First Aid: Exp Date: First Responder: Exp Date: ____
EMT or above: Level of Training: Exp Date:
BSA Lifeguard: Exp Date: Red Cross Lifeguard: Exp Date:
BSA National Camping School: Which Area? Exp Date:
BSA Youth Protection: Date Taken: Weather Hazards: Date Taken:
CLASS SURVEY
Please check the merit badge or rank advancement classes that you would be willing to teach. Choose as many as you feel qualified to teach, minimum of two. We will pick two or three that best fit our program. The class period is 90 minutes. Please indicate if the class requires a double period.
Double Period
Tenderfoot......
Second Class......
First Class......
C.O.P.E ......
AQUATICS
BSA Lifeguard......
Canoeing......
Kayaking......
Lifesaving......
Motorboating......
Rowing......
Small-Boat Sailing.....
(2 week course)
Snorkeling BSA......
Swimming.......
Water Sports......
SHOOTING SPORTS
Archery ......
Rifle Shooting ......
Shotgun Shooting ......
(Black Powder)
ARTS & CRAFT
Art ......
Basketry ......
Leatherwork ......
Metalwork......
Painting ......
Pottery ......
Sculpture...... / Double Period
Woodcarving......
Woodwork ......
SCOUT CRAFT
Camping......
Cooking......
Emergency Prep......
First Aid......
Hiking ......
Indian Lore ......
Orienteering ......
Paul Bunyan Woodsman
Pioneering......
Wilderness Survival ....
SCIENCES & CONSERVATION
Archeology......
Astronomy......
Bird Study......
Computers......
Electricity......
Electronics......
Environmental Science
Geology......
Insect Study......
Mammal Study......
Nature......
Nuclear Science......
Plant Science ......
Soil & Water
Conservation......
Weather...... / Double Period
OTHER
Auto Maintenance......
Aviation......
Climbing......
Cycling......
Citizenship in the
Community ......
Citizenship - Nation
Citizenship - World
Communication ......
Engineering......
Fire Safety......
Fishing ......
Golf......
Home Repairs......
Law......
Music......
Personal Fitness......
Personal Management
Photography......
Public Speaking......
Railroading......
Safety......
Salesmanship......
Textile......
Theater......
OTHER
Please note any prerequisites that the boys shouldcomplete before camp (please be sure to indicate which merit badge):