Philmont Registration Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Scout's name *FirstMiddleLastBoy Scout's date of birth *Grade Completed (Prior to Trek) *Choice 7789101112Gender *Choice 3M- MaleF - FemaleHeight (inches) *Weight (lbs) *BSA Member ID # (If unknown please put "unknown" in box and we will look up) *Ethnicity *WhiteHispanicBlackAsianAmerican IndianPacific IslanderOtherReligious Preference *Roman CatholicJewishLatter-Day SaintsChristian-ProtestantBuddhistMuslimHinduEastern OrthodoxOtherAddress Line 1 *Address Line 2City *State *Zip Code *Email *Scout Rank *Choice 9ScoutTenderfootSecond ClassFirst ClassStarLifeEagleNumber of Prior Treks *Wilderness First Aid *Choice 9I'm not certified.Yes. I am certifiedWFA certification expiration date (if certified)CPR *Choice 9I'm not certified.Yes. I am certifiedCPR certification expiration date (if certified)Medical Allergies *Choice 18-None-EggsMilk/DairyPeanutsTree NutsSoyWheatShellfishFishSesameGlutenReligious Food PreferenceChoice 9-None-HalalKosherOther Food PreferenceChoice 9-None-VegetarianVeganParent/Guardian Name *FirstLastParent/Guardian Email *Parent/Guardian Phone *Emergency Contact (Primary) Contact Name *FirstLastShould be 18+ and not going on the trek, for youth please include parent/guardian.Emergency Contact (Primary) Relationship to Participant *Emergency Contact (Primary) Contact Phone Number *Emergency Contact (Primary) Phone Type (copy) *HomeCellWorkEmergency Contact (Secondary) Contact NameFirstLastShould be 18+ and not going on the trek, for youth please include parent/guardian.Emergency Contact (Secondary) Relationship to Participant (copy)Emergency Contact (Secondary) Contact Phone NumberEmergency Contact (Secondary) Phone TypeHomeCellWorkSubmit
Troop 730 | Provo Utah
Troop 730 | Provo Utah