Registration Assistance Request

"*" indicates required fields

Date*

Is The Applicant New to Scouting?*

Yes

Unit Type & Number*

Ex: Pack 123, Troop 123, Ship 123, Crew 123

District

Name of Applicant*

First Last

Name of Parent/Guardian*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Leader Name*

First Last

Leader Phone*

Leader Email*

Briefly explain the circumstances or need for individual registration assistance.*

Unit Participates in

Friends of Scouting

Popcorn Sales

Scouting for Food

Parent is a Leader

Amount Scout and family can pay*

Amount Unit and Charter can pay*

Other Financial Assistance Received (unit fundraiser, popcorn sales, other):*

Amount of Assistance Requested:*

Up to 50% of the registration fee and are not transferable.

Name

First Last

This field is for validation purposes and should be left unchanged.

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