Please
provide as much information as you are comfortable providing. This
information will be kept confidential in the troop records and will not be
released to anyone without your prior consent.
Son's Name(s)
Father's
Information
Mother's
Information
Name
Name
Spouse Name (if not boy's mother)
Spouse Name (if not boy's father)
Address
Address
City, State, Zip
City, State, Zip
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Other Phone
Other Phone
Email Address
Email Address
Birthdate (at least Month &
Day)
Birthdate (at least Month &
Day)
Drivers' License Number, State
Drivers' License Number, State
Employer
Employer
Occupation
Occupation
Were you a Boy Scout
Highest Rank Attained, Date,
Troop #, Location
Emergency Contact & Phone
Number
Family Doctor & Phone Number
Insurance Company
Policy Number
Known Allergies
(son's)
The
following information is required to be on file if you will be driving
boys to and from campouts or other scouting events.