2012 SCOUT APPLICATION

Home Troop Number: *

Scout's Last Name: *

Scout's First Name : *

Phone Number: *

000-000-0000 Area Code - Phone Number

How many years of Mackinac Experience?: *

How old will you be on May 28, 2012?: *

Email Address:

Current Rank: *

Birth Date: *

Alternate Phone Number:

ooo-ooo-oooo Area Code - Phone Number

Alternate Phone Number belongs to:

Second Alternate Phone Number:

ooo-ooo-oooo Area Code - Phone Number

Second Alternate Phone Number belongs to:

Father's Name:

First and Last

Father's Email Address:

Mother's Name:

First and Last

Mother's email address:

Street Address: *

City: *

State: *

Zip Code: *

List any Medical, Dietary, or Food allergy we should be aware of.: *

If yes to the above question do you want to play in: *

	YES	NO
The Drum and Bugle Corp.?
The Drum and Bugle Patrol?

D&B Corp. is for all.
D&B Partol is for only those with one year Mackinac Experience.

If you served at Mackinac what were the years you attended?: *

2009 or 2009,2010 or 2009 thru 2011.

List Positions Held on the Island: *

Member, Assistant Patrol Leader, Patrol Leader, Assistant Senior Patrol Leader, Senior Patrol Leader, Caplain's Aide, Bugler, Member D&B

List Positions Held in your home troop: *

Member, Assistant Patrol Leader, Patrol Leader, Assistant Senior Patrol Leader, Senior Patrol Leader, Quarter Master, Chaplain's Aid, Scribe, Historian, etc.

Scouting Awards:

Arrow of Light, Religious Award, etc.

Order of the Arrow Membership and offices:

Scouting Training (Courses taken and dates):

NYLT, Troop Leadership training, Den Chief, etc.

List any ather Extra Curricular Activities you are involved with:

Are you certified: *

	YES	NO
CPR
First Aid

RANK Expected on May 28, 2012:

State why you have decided to participate in the Mackinac Island service troop: *

What do you expect to gain from the experience?: *

Are you interested in serving on the Quartermaster Corp.? Boys with at least one year of MISST service ONLY:

	YES	NO
Interested?

Home Scoutmaster's Name: *

first and last

2012 INFO

Countdown

	YES	NO
Bugle
Trumpet
Drums