$25.00
December 3rd
Mitch Park YMCA
Scout(s) Name * (optional)
Additional Youth going? (optional) No1 ($25.00)2 ($50.00)3 ($75.00)4 ($100.00)
I give permission for my scout(s) and/or youth to attend this activity. * (optional) YesNo
Does your Scout(s) have any Restrictions or Special Considerations? (If so please explain) (optional)
Parent / Guardian's Name * (optional)
Parent / Guardian's Cell Phone * (optional)
Hold Harmless Agreement - I understand that participation in Scouting activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and have given consent for myself and/or my scout to participate in this activity. I also understand that participation in this activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Scouts BSA, The Last Frontier Council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation. * (optional)
I will attend this event * (optional) NoYes ($25.00)
Additional Adult (optional) noAdditional Adult ($25.00)2 Additional Adults ($50.00)
If attending, how many Seat Belts (Including the Driver) do you have? (optional)
Make, Model, Color, and Tag of your Vehicle: (optional)
Driving Comments? (i.e. will be driving with someone, will be driving down on Saturday, etc..,) (optional)
