Blast Summer Adventure Registration
Thank you for taking the time to Register your son or daughter for BSA!! We look forward to serving you.
Child Information
Child's Name
*
Gender (Choose One)
*
Please select all that apply.
Male
Female
Birthday
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Grade Entering
*
Please select one option.
Preschool (3-5 yrs.)
Kindergarten
1st
2nd
3rd
4th
5th
6th
Select Option
Preschool (3-5 yrs.)
Kindergarten
1st
2nd
3rd
4th
5th
6th
List any allergies
*
Epi-Pen
*
Please select one option.
Yes
No
T-Shirt Size
*
Please select one option.
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
Select Option
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
Emergency Contact Information
Name of Parent / Guardian
*
Relationship to Child
*
Home Phone
Mobile Phone
*
Can we text you?
*
Please select one option.
Yes
No
Email
*
This address will receive a confirmation email
Address (If different than child)
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Approved for Pick-up
Please list the name & relationship of anyone else who is approved to pick up your child:
Submit
Description
Thank you for taking the time to Register your son or daughter for BSA!! We look forward to serving you.
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