2015 Registration for Troop 616Return form and check by February12th
Scout, Family & Vehicle Information for New Scouts
Welcome! We’ve made the registration process even easier this year. To complete:
- Enter the applicable information listed below and sign/date the form.
- Attach your check for $175 per Scout made payable to ‘BSA Troop 616’ ($125 annual dues + $50 one-time equipment fee).
- Drop off or mail to Don Tait 11590 Trailbrook Ln. San Diego, 92128 . Forms must be received by February 12th.
Scout Information:
Name: / Birth Date: / Address:Home Phone: / Cell Phone: / Email(s):
Parent or Guardian Information:
Name: / Driver’s License: / Cell Phone: / Email(s):Employer: / Occupation: / Work Phone:
List Prior Pack Leadership: (if applicable) / See the attached list and indicate which Troop 616 Leadership roles, if any, interest you: (optional)
Name: / Driver’s License: / Cell Phone: / Email(s):
Employer: / Occupation: / Work Phone:
List Prior Pack Leadership: (if applicable) / See the attached list and indicate which Troop 616 Leadership roles, if any, interest you: (optional)
Vehicle Information:
If you have more than two cars insured, list just the two cars that you would use for Boy Scouts.
Year / Make / Model / # of Seatbelts: / License Plate: / Insurance Coverage Limits (thousands)Per Person / Per Accident / Property Damage *:
Year / Make / Model / # of Seatbelts: / License Plate: / Insurance Coverage Limits (thousands)
Per Person / Per Accident / Property Damage *:
Releases & Agreements
Troop Website Release: By signing below, we consent to the use of our contact information, voice and/or photograph in the website, news coverage or similar projects approved by Troop 616. We understand that our contact information will be in the secure password-protected area of the troop website and that photograph captions will not identify scouts by name.
Consent to Abide by Troop Bylaws & Policies: By signing below, we acknowledge that we have received access to our copy of the Bylaws and Policy Handbook for BSA Troop 616 and agree to abide by the provisions contained therein.
* Vehicle Insurance Policy: All vehicles that carry troop members to events and activities must be covered by liability and property damage liability insurance. The amount of this coverage must meet or exceed the insurance requirement of the state in which the vehicle is licensed. It is recommended, however, that coverage limits are at least $50,000 / $100,000 / $50,000 (per person, per accident, property damage). Any vehicle carrying 10 or more passengers is required to have limits of $100,000 / $500,000 / $100,000. In the case of rented vehicles, the requirement of coverage limits can be met by combining the limits of personal coverage carried by the driver with coverage carried by the owner of the rented vehicle. All vehicles used in travel outside of the United States must carry a public liability and property damage liability insurance policy that complies with or exceeds the requirements of that country.
Signatures – Both the parent and the Scout must sign:
Parent/Guardian:______Date:______
Scout:______Date:______