Heart of America Council Boy Scouts of America
YOUTH SPECIAL NEEDS REQUEST
REQUEST FOR PHYSICAL ARRANGEMENTS ASSISTANCE
****INCLUDES SPECIAL DIETARY REQUESTS****
MUST BE COMPLETED BY
JUNE 1, 2018
Please Print or Type
Unit Type: Unit Number: District:
(Troop, Crew, etc)
If Summer Camp, Session, Camp, and Campsite:
Event Name:
Unit Leader Making Request: Phone #: (____)
Request Made For (Name of Youth): Age
Type of Physical Arrangement, Assistance Requested or Special Dietary Request:
Date Filed with Camping Services: Copy to Reservation on:
Copy to Dining Hall Coordinator on _____________ Other:
Return to: HOAC, 10210 Holmes Rd, Kansas City, MO 64131 fax: 816-942-8086
51
THIS PAGE INTENTIONALLY LEFT BLANK
52
National Summertime Pack
Award Application
Cub Scout Pack No. _________________ of Chartered Organization_____________________________________________________________
Name
has qualified for this award by conducting a pack activity in the summer months of _______________.
Year
JUNE JULY AUGUST
Type of pack activity __________ __________ __________
Number of dens participating __________ __________ __________
Number of dens qualifying (50 percent of the den’s __________ __________ __________
Cub Scouts participating)
Number of the pack’s Tiger Scouts participating __________ __________ __________
Number of the pack’s Wolf Scouts participating __________ __________ __________
Number of the pack’s Bear Scouts participating __________ __________ __________
Number of the pack’s Webelos Scouts participating __________ __________ __________
Number of parents/family members participating __________ __________ __________
Please send us the following National Summertime Pack Award items:
SKU 33731 2015 Printing
Cub Scout 33731
NATIONAL SUMMERTIME PACK AWARD Presented to Cub Scout Pack
Chartered organization ________ Tiger pins, No. 14332
________ Wolf pins, No. 14333
City State
District Council
By the Boy Scouts of America for conducting ©2015 Boy Scouts of America
an effective summertime program
Year
Council representative Chief Scout Executive
One Pack Award Certificate, No. 33731
One Pack Award Streamer, No. 17808 ________ Bear pins, No. 14334
________ Webelos pins, No. 14335
________ Den participation ribbons, No. 616254
SUMMERTIME ACTIVITIES TRACKING SHEET
JUNE
Leader(s) responsible_______________________________________________________________________________________________
Pack activity______________________________________________________________________________________________________
Location____________________________________________ Date__________________________________ Time__________________
Number of dens that participated ________ Number of dens with at least 50 percent of members present ________
Number of Tiger Scouts participating ________ Number of Wolf Scouts participating ________
Number of Bear Scouts participating ________ Number of Webelos Scouts participating ________
Number of parents/family members participating ________
Comments _______________________________________________________________________________________________________
JULY
Leader(s) responsible_______________________________________________________________________________________________
Pack activity______________________________________________________________________________________________________
Location____________________________________________ Date__________________________________ Time__________________
Number of dens that participated ________ Number of dens with at least 50 percent of members present ________
Number of Tiger Scouts participating ________ Number of Wolf Scouts participating ________
Number of Bear Scouts participating ________ Number of Webelos Scouts participating ________
Number of parents/family members participating ________
Comments _______________________________________________________________________________________________________
AUGUST
Leader(s) responsible_______________________________________________________________________________________________
Pack activity______________________________________________________________________________________________________
Location____________________________________________ Date__________________________________ Time__________________
Number of dens that participated ________ Number of dens with at least 50 percent of members present ________
Number of Tiger Scouts participating ________ Number of Wolf Scouts participating ________
Number of Bear Scouts participating ________ Number of Webelos Scouts participating ________
Number of parents/family members participating ________
Comments _______________________________________________________________________________________________________
Date needed_______________________________ Cubmaster signature_______________________________________________________
Pack committee chair signature______________________________________________
Send to ____________________________________________ _____________________________________________________________
Name Street, city, state, zip code
TO ASSURE PROMPT RECOGNITION, SUBMIT APPLICATION TO LOCAL COUNCIL SERVICE CENTER AS SOON AS
POSSIBLE AFTER YOUR AUGUST ACTIVITY.
512-049
2015 Printing
Heart of America Council Boy Scouts of America
Camp Transfer Request
District ___________ Unit # ______ Primary Contact Name __________________________________
____Bartle Boy Scout Camp ____Webelos Resident Camp
____Naish Boy Scout Camp ____Bear Resident Camp
____Rotary Boy Scout Camp ____Cub Scout Day Camp
Session_______ Camp _______________________ Campsite_______________________________
Names of Scout __________________________ __________________________
__________________________ __________________________
Names of Full-time Leader __________________________ __________________________
__________________________ __________________________
Names of Part-time Leaders __________________________ __________________________
__________________________ __________________________
Transfer reservations to:
____Bartle Boy Scout Camp ____Webelos Resident Camp
____Naish Boy Scout Camp ____Bear Resident Camp
____Rotary Boy Scout Camp ____Cub Scout Day Camp
Session_______ Camp _______________________ Campsite______________________________
*Camping with District ___________ Unit # ______ Primary Contact Name ______________________
___ (√) These Scout(ers)/registration(s) are transferring their BSA membership to this unit. Registration and
funds totaling $________ will be transferred to the new unit.
We authorize the Heart of America Council, BSA to transfer the above reservations. We fully understand
that the primary unit will be financially responsible for these reservations unless their BSA membership is
transferred.
___________________________________ ______________________________ ____________
Unit Leader Signature (Scoutmaster or Cubmaster) Committee Chairman Signature Date
We have agreed to provide leadership for the above Scouts and Scouters.
___________________________________ ______________________________ ____________
*Unit Leader Signature (Scoutmaster or Cubmaster) * Committee Chairman Signature Date
Miscellaneous:Forms:Camp Transfer Request:lbc 55 11/16/10
SCOUT OATH
On my honor I will do my best
To do my duty to God and my country
And to obey the Scout Law;
To help other people at all times;
To keep myself physically strong,
Mentally awake, and morally straight.
SCOUT LAW
A Scout is:
Trustworthy
Loyal
Helpful
Friendly
Courteous
Kind
Obedient
Cheerful
Thrifty
Brave
Clean
Reverent
56