2013-2014 Troop 33 Adult Registration Form
Boy Scouts of America Sponsored by the Los Altos United Methodist Church
Last name of the scout for whom you are parent/guardian:
First name of the scout for whom you are parent/guardian:
Opt out of Troop 33 directory
Troop 33 maintains parents' email and phone numbers in Google Sites. This is a private site accessible only by Troop 33 members.
I give permission to list my email and phone number on this restricted site
I wish to opt out of listing my email and phone number on this private site
Parent/Guardian 1 last name
Parent/Guardian 1 first fame
Parent/Guardian 1 home number
Parent/Guardian 1 work number
Parent/Guardian 1 cell number
Preferred phone for scouting
Parent/Guardian 1 email
Parent/Guardian 2 last name
Parent/Guardian 2 first name
Parent/Guardian 2 home number
Parent/Guardian 2 work number
Parent/Guardian 2 cell number
Preferred phone for scouting
Parent/Guardian 2 email
Part 1: Adult Youth Protection Training (YPT) Certificate
To join Troop 33 you are required to have completed your YPT and you must have your YPT certification current at all time. NO EXCEPTION will be made, since we are expected to a strict adherence to this BSA mandate. For details go to http://www.scouting.org/YouthProtection.aspx, create an account and complete the online YPT training.
YPT Training Certification
You must complete your YPT training first and attach the valid copy of your YPT Certificate to this document. We need one certificate per parent but one is sufficient for this application.
I have emailed my YPT certificate to Troop 33 Recruiting
Part 2: Vehicle information:
For details go to Vehicle: http://www.scouting.org/scoutsource/HealthandSafety/Alerts/Insurance.aspx For those who would like to drive on Troop outings, we are required by the local BSA council to provide vehicle and driver information for those who volunteer to drive. Whenever Troop 33 schedules an outing, it must file a Local Tour Permit Application with the local BSA council, or a National Tour Permit for all outings away from home area. As part of this application, the Troop must provide a list of driver and vehicle identification, along with vehicle insurance coverage. The insurance coverage must meet the national BSA requirements and recommendations as stated below. If you plan to drive please read these requirements. Please inform the Troop of any changes in vehicle usage or insurance coverage.
Vehicle 1: What type, make and model of vehicle might you be able to use for scout outings? (Optional)
Year, make, model (i.e., 2008 Toyota Sienna)
Vehicle 1: Number of seatbelts
Vehicle 2: What type, make and model of vehicle might you be able to use for scout outings? (Optional)
Year, make, model (i.e., 2008 Toyota Sienna)
Vehicle 2: Number of seatbelts
Part 3: Medical forms & health insurance information:
For details go to Medical: http://www.scouting.org/scoutsource/HealthandSafety/ahmr.aspx (If you don't have access to a scanner, please check "Other" below.)
Agree to provide current medical & health insurance info
This is required for adult participating and going on regular outings, including day trip and/or overnight outings. I hereby acknowledge to have or will provide my most current updated BSA medical forms and health insurance card copy in accordance with BSA requirement, when I participate in any and all troop outing. I have read, understood and will comply with all related BSA requirements.
BSA Annual Health and Medical Record
I have completed, scanned and emailed parts A & B. (Part C requires a doctor's signature and can be turned in later.)
Health insurance card
I have scanned and emailed my health insurance card (both sides)
Do you have CPR training
Date of expiration for CPR training
Do you have First Aid training
Date of expiration for First Aid training
Level of First Aid training
Part 4: Adult Desired Volunteer Role:
Each family is expected to help in at least two ways: 1. Committee Member OR Activity Coordinator, and 2. Merit Badge Counselor OR Board of Review Member
I am planning on helping Troop 33 with
Merit Badge counseling
Board of Review
Part 5: Acceptance
I agree to comply with ALL the Rules and Regulations of the Boy Scouts of America, the local council and Troop 33. I affirm that the information I have provided with this registration is true and correct. As a registered adult with Troop 33, I understand that I may have access to confidential information regarding its members. I will not willingly use or disclose membership information for purposes other than sanctioned Troop 33 activity.
Adult (virtual) Signature
Troop will pay BSA registration fee for an adult when he/she is a parent or a guidance of registered scout/s in the troop. All others are requested to pay $15 (does NOT include annual subscription for Boys Life) BSA annual fees as “Adult” member of the BSA/troop 33.Please make your registration fee payment check, payable to “Troop 33” and print your name on memo.
Youth Protection Training
As per new BSA mandate, effective July 2010, all registered adult volunteers must have completed their YPT and must maintain his/her YPT certification current at all time as a member of the BSA/troop. Therefore all adult membership (new or renewal) registration application required to have valid copy of his/her YPT certificate. The YPT certification is earned and is good for 2 years upon completing required on-line training • If you have completed your on-line YPT training within last 2 years, but don’t have copy of your valid certificate, you can retrieve it by login in to your account at https://myscouting.org web site • If you have not taken this BSA mandated training and/or your YPT certification has expired, take the on-line training (it takes ~ 45 min) at http://www.scouting.org/YouthProtection.aspx first, print the certificate at completion of the training, and submit this certificate with your troop registration/renewal form.
Vehicle Insurance Information for Drivers
For those who would like to drive on Troop outings, we are required by the local BSA council to provide vehicle and driver information for those who volunteer to drive. Whenever Troop 33 schedules an outing, it must file a Local Tour Permit Application with the local BSA council, or a National Tour Permit for outings over 500 miles away from home area. As part of this application, the Troop must provide a list of driver and vehicle identification, along with vehicle insurance coverage. The insurance coverage must meet the national BSA requirements and recommendations as stated below. If you plan to drive please read these requirements. Please inform the Troop of any changes in vehicle usage or insurance coverage. National BSA requirements: “All vehicles MUST be covered by a public liability and property damage liability insurance policy. The amount of coverage must meet or exceed the insurance requirement of the *State in which the vehicle is licensed. (It is recommended, however, that coverage limits are at least $50,000/$100,000/$50,000) Any vehicle carrying ten (10) or more passengers is required to have limits of $100,000/$500,000/$100,000. In the case of rented vehicles, the requirement of coverage limits can be met by combining the limits of personal coverage carried by the driver with coverage carried by the owners of the rented vehicle. All vehicles used in travel outside the United States must carry a public liability and property damage liability insurance policy that complies with or exceeds the requirements of that country.” IMPORTANT: On Troop outings, all drivers and passengers must wear seat belts. The only exceptions are travel by school or commercial bus. All drivers must have a valid California driver’s license and they must be at least 18 years old. Driving speed must be in accordance with state and local laws. Driving time is limited to a maximum of 10 hours per day and must be interrupted by frequent rest, food, and recreation stops. If a truck is used, passengers may only ride in the cab.
BSA Medical Forms must be updated annually. Please be sure your copy is on-file and up-to-date. Troop 33 Medical and Insurance form coordinator, will collect required updated Medical form/s in the spring. For more information on medical forms requirements go to BSA site at http://www.scouting.org/scoutsource/HealthandSafety/GSS/gss11.aspx and for downloading BSA medical forms go to BSA web site at http://www.scouting.org/filestore/pdf/34605_Letter.pdf
Please don't submit the form until after the Application Start Date. Order of application is based on timestamp of online forms and scanned documents email *after* the start date.
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