2017 Cub Scout Camping Registration

Registration will not be accepted without a completed Annual Health and Medical Record:

Scouts Name_________________________________________________Age___________

Address_________________________City_____________________State______Zip_________

Home Phone (_____)____________ Birthdate_____/_____/_____Grade in Fall of 2017_______

Pack#______District______________Email__________________________________________

2017 Cub Scout Camping Registration

Fill in below only if attending Adventure Weekend or Webelos Adventure Weekend:
Parent or Guardian Attending
*a parent/guardian is required to attend Adventure Weekend and Webelos Adventure Weekend*

Name__________________________________ Gender_____ Relationship_______________

Daytime Phone (______)_______________Evening Phone (______)_____________

Additional Parent/Guardian________________________Gender _____Relationship__________

Additional Camper_______________________________Age_____Grade in Fall 2017________

(must be a sibling of the Scout above)
There are two camping options for Timber Pointe Adventure Weekend only:

Additional Shirts $10 _____ (one complimentary youth shirt is included with registration)
Youth T-shirt Sizes: YS_____ YM_____YL_____AS_____AM_____AL_____
Adult T-shirts: AS______AM_____AL______XL______2X_______3X______
Additional Shirt for: Adventure Camp Adventure Weekend Webelos Adventure Weekend (circle )

Adventure Camp Adult Walkers:

Two Adult Walkers are required for each day of camp for every ten (10) Scouts from the same Pack.
Speak with your Packs leadership to ensure that Adventure Camp Adult Walkers are scheduled.
All Adventure Camp Adult Walkers must submit the Annual Health & Medical Record (Part A & B).
Walkers who register and are present all 5 days of camp will receive one complimentary adult shirt.
I will serve as an Adult Walker on the following days (circle):
Mon. Tues. Wed. Thurs. Fri. Sat.

Walkers Name:________________________________________Phone: (_____)____________________

Email:________________________________________________5 Day Walker Shirt Size: ___________

Swimming Permission: (Check One) * Pontiac, Bloomington, Princeton Adventure Camps; Timber
Pointe and Ingersoll Scout Reservation Adventure Weekends.
____Beginner (Shallow Water only) ____ Swimmer ____ My child is not permitted to swim

Please make checks payable to W. D. Boyce Council For Office Use only:
and mail with registration and health forms to:
W. D. Boyce Council Date Received:______ Health Record:______
614 NE Madison Ave
Peoria, IL 61603 Notes:________________________________
 2017 Cub Scout Camping Registration
Registration will not be accepted without completed Annual Health & Medical Record: Parts A & B must be
completed by every youth and adult.
Adventure Camp: Date and Time Volunteer Camp Early Bird Due EB cost is $100 per Total Cost
Open to all Cub Scouts Director Dates youth on/before due
Tigers through Webelos date. Regular cost is
$125 per youth.
Canton June 5 to 9 Mike Charlesworth
Youth Acres 8:30am to 4:00pm (847) 997-1200 May 5th ____Scouts @$_____ $_____
Princeton June 5 to 9 Theresa Sartain
City Park 8:30am to 4:00pm (815) 252-6678 May 5th ____Scouts @$_____ $_____
Pontiac June 12 to 16 Dave Gallup
Humiston Woods 8:30am to 4:00pm (815) 674-5825 May 5th $_____
____Scouts @$_____

Morton June 12 to 16 Mary Barrick

Kennel Lake 8:30am to 4:00pm (309) 360-3689 May 5th $_____
____Scouts @$_____

Clinton June 19 to 23 Christina Soberalski

May 5th
4-H Fairgrounds 8:30am to 4:00pm (217) 433-9862 ____Scouts @$_____ $_____
Bloomington June 19 to 23 Glenn Harbin
May 5th
Comlara Park 8:30am to 4:00pm (309) 287-4267 ____Scouts @$_____ $_____
Peoria July 10 to 14 Mike Charlesworth
Sommer Park 8:30am to 4:00pm (847) 997-1200 June 2nd $_____
____Scouts @$_____

Mapleton July 17 to 21 Ranae Pincock

June 2nd
Butler Haynes Park 8:30am to 4:00pm (309) 264-7228 ____Scouts @$_____ $_____
Oglesby July 24 to 28 Mike Walker
June 2nd
Lehigh Park 8:30am to 4:00pm (815) 274-2052 ____Scouts @$_____ $_____
Adventure Weekends: Date and Time Volunteer Camp Early Bird Due Early Bird Cost : $200 Total Cost
Open to all Cub Scouts Director Dates per youth/adult pair
Tigers through Webelos Regular: $220
Additional: $90
Lake Bloomington July 14 12:00pm to Glenn Harbin ___Pair(s) @ $______
Timber Pointe Camp July 16 12:00pm (309) 287-4267 June 2nd
___Additional @ $90 $_____
London Mills July 21 1:00pm to Todd Evans ___Pair(s) @ $______
Ingersoll Scout Reservation July 23 12:00pm (309) 660-4516
June 2nd ___Additional @ $90 $_____
Webelos Adventure Weekends: Open to Webelos only (4th and 5th Grade in Fall of 2017) Early Bird cost is $180 per youth/
adult pair. Regular cost is $200 youth/adult. Additional Youth Camper is $130. Additional Adult Camper is $80.
Webelos Session #1 June 9 12:00 pm to Glenn Harbin ___Pair(s) @ $______
Lake Bloomington June 11 12:00pm (309) 287-4267
May 5th
Camp Peairs ___Addl Youth $____
___Addl Adult $____ $_____
Webelos Session #2 July 21 1:00pm to Austin St. George ___Pair(s) @ $______
London Mills July 23 12:00pm (309) 673-6136
Ingersoll Scout Reservation x128 June 2nd ___Addl Youth $____
___Addl Adult $____ $_____
Webelos Session #3 July 28 1:00pm to Austin St. George ___Pair(s) @ $______
London Mills July 30 12:00pm (309) 673-6136
Ingersoll Scout Reservation x128 June 2nd ___Addl Youth $____
___Addl Adult $____ $_____
Please make checks payable to W. D. Boyce Council and mail Registration Summary:
with registration and health forms to: Total Fees from above: $_______
W. D. Boyce Council Additional T-shirts ($10 per): $_______
614 NE Madison
Total Registration: $_______
Peoria, IL 61603