2021 Medicine Mountain Summer Camp Sign Up (June 12 to June 19, 2021)
NOTE: This same information is available on the Troop 171 Website.

This is the SIGN-UP form for summer camp form! IT IS NOT THE FINAL PERMISSION SLIP or DRIVER INFORMATION SHEET!

We have confirmed reservations for summer camp at Medicine Mountain Scout Ranch in South Dakota. Now it is time to get confirmed names and payments.

* CAMP DATES: Saturday, June 12 to Saturday, June 19, 2021
* WHO: Open to ALL Scouts in Troop 171G and Troop 171B
* ADULTS: We need adults other than the Scoutmaster staff to help with Boards of Review
and other advancement at camp.
* DRIVERS: We will need drivers to and from camp on the dates above. We ALSO will need
enough drivers for the out-of-camp excursion on Wednesday.

• COST (best estimate at this time) - Detailed pricing is below:
Medicine Mountain Summer Camp: $450 for basic summer camp if paid in full by
March 15, 2021. Note: This is an estimate only and is based on the Early Bird Pricing
from Med. Mtn. The cost includes camp registration, transportation to and from camp,
and travel food. Costs increase after early bird pricing ends.
Some merit badges that have kits or supplies are extra.
High adventure fees are extra as well (see details below).

Total Costs Estimate:
No High Adventure (all Scouts) $450.00
One High Adventure (14 and above) $525.00
Two High Adventures (14 and above) $600.00

• HIGH ADVENTURE PROGRAM INFORMATION (Available to Scouts age 14 and older at the
time camp starts):
Each 2-day high adventure has an ADDITIONAL cost of $75. Scouts can choose either
∞ Option A - a single high adventure program and 2 merit badge classes OR
∞ Option B - two high adventures and no merit badge classes.

High Adventure Program offers three, 2-day modules for Scouts age 14 and older
at the time of camp starts to choose from:
Daytime Blocks ($75 each):
• New Heights Program (Natural Rock Climbing)
• Spelunking Program (Caving)
• Trails & Dust Program (ATVs)

Evening Blocks - does not interfere with mb classes:
• Wheels & Gears Program (Mountain Biking) Special pricing - $20 per evening
ride

SPECIAL NOTE FOR HIGH ADVENTURE SCOUTS: WE NEED A FIRM COMMITMENT
FOR THESE HIGH ADVENTURE COURSES BECAUSE THEY HAVE A LIMITED CLASS
SIZE AND FILL FAST!

SPECIAL NOTE FOR PAYMENT: Scouts can sign up for High Adventures and Merit Badges when they have paid a total of $300 for Merit Badges or $375 (or $450) for High Adventures. It is important to reach this deadline as soon as possible IF you are hoping to register for any of the High Adventure programs since they fill up fast.

• DRIVERS: We will ask for drivers as we get closer to summer camp. The driver information will come out with the final permission slip.
Email address *
Summer Camp Costs, Payment Schedule and Refund Policy
The costs shown below are our best estimate of total fees. This includes not just the Medicine Mountain Scout Ranch fees. It also includes our best estimate for gas, food for our early arrival and miscellaneous program fees.

PAYMENT SCHEDULE: Base summer camp fee. High Adventure fees are extra and due ASAP to improve chances of getting a spot at registration.
WE CANNOT SCHEDULE HIGH ADVENTURES UNTIL PAID IN FULL.

Payments due to Kathy Brown [Troop 171 Treasurer]

Camp Scholarships are available on a need basis. Please contact Kathy Brown or a Scoutmaster if you have a financial need. We WANT every Scout to be able to attend summer camp!

Basic Camp Fee Payment Schedule for Scouts NOT taking a High Adventure Program option [total due $450]
- Deposit: $150 DUE with Signup
- Payment #2 due by March 10: $175 [$325 to date]
- Final Payment due by May 1: $125 [$450 to date]
================================
High Adventure (costs in addition to the $450 above)
- [Scout age 14 and above at the time of camp]
- Options: Caving, Rock Climbing, Mountain Biking or ATV’s
- $75 for one High Adventure [2 days] [Total Cost including the basic camp fee $525]
- $150 for two High Adventures [4 days] [Total Cost including the basic camp fee: $600]

- DUE at SIGN UP to register in High Adventure Program:
∞ One H.A. program: $400 [$325 camp fee + $75 High Adventure fee]
∞ Two H.A. programs: $475 [$325 camp fee + $150 High Adventure fee]
- Final Payment due by May 1: $125
- one High Adventure [2 days] [Total Cost including the basic camp fee $525]
- for two High Adventures [4 days] [Total Cost including the basic camp fee: $600]
================================
Payment
We currently have four ways you can pay Summer Camp Fees:

1. Mail (address below) a paper check made out to "BSA Troop 171".

2. Transfer funds via VENMO. Search for @BSA171Boulder . You'll know you have the right account when you see a picture of the Troop patch (the one on your Scout's neckerchief.) NO FEES associated with this method of payment!

3. Transfer through your PayPal account with NO FEES (be sure to choose the transfer option). In your PayPal account, just "friend" the email address "treasurer@bsa171.org" and you can transfer funds with no associated fees.

4. You can also pay with a credit card via PayPal (FEES WILL APPLY). Any associated fees will be billed to your Scout account (about 3%). Search for our PayPal account by email address "treasurer@bsa171.org".

Kathy Brown
907 Brooklawn Dr.
Boulder, CO 80303
303.229.4148
kathybrown171@gmail.com
Refund Policy
Refund Policy - based on MMSR policy:
∞ Refunds are not available for vacations, sports, band, events, summer school, school events
or changing one’s mind.
∞ $50 per person is non-refundable for individual cancellations.
∞ 30+ days before the start of your units week at summer camp: Everything less $50 non-refundable
per individual or 10% of total fees paid for entire group cancellation.
∞ 10 to 29 days before the start of the event: $200 refundable per person even for entire group
cancellations.
∞ Under 9 days prior to, during or after camp: No Refund.
∞ Until the start of camp for all medical issues documented by a Medical professional:
TBD. A minimum of $50 is non-refundable. The remaining paid balance may be refunded in
full for a medical issue upon the approval of the refund committee.
Scout or Adult *
Is this registration for a Scout, Adult/Parent or Scoutmaster Staff? Please complete a SEPARATE form for each Scout and adult interested.
Troop *
With which troop are you affiliated? Please use a separate form for each Scout or adult registering to attend camp.
Scout Name - Troop 171 B
Name of Scout signing up for Medicine Mountain Summer Camp. PLEASE USE A SEPARATE REGISTRATION FOR EACH PERSON GOING TO CAMP!
Scout Name - Troop 171 G
Name of Scout signing up for Medicine Mountain Summer Camp. PLEASE USE A SEPARATE REGISTRATION FOR EACH PERSON GOING TO CAMP!
Adult Name - Attending Camp
Name of ADULT signing up for Medicine Mountain Summer Camp. PLEASE USE A SEPARATE REGISTRATION FOR EACH PERSON GOING TO CAMP!
Name - Going to camp, but not on list above
If you are registering for camp as a Scout or as an adult and your name is NOT on the pull down lists above, please enter it here. PLEASE ENTER AS: Last Name, First Name
Age - Scout
Scout age AS OF CAMP IN JUNE.
Rank
Expected or planned rank when you go to to camp. This will help us organize your classes. This is just a guess and we know it may change. NEW SCOUTS - there is an option for you on this list as well!
Fees Total *
Estimated final fees. Please complete a separate form for each Scout and adult camping with the troop. See troop website or pricing above for details.
T-Shirt Size *
SCOUTS or ADULTS staying at camp - please enter your t-shirt size for the camp shirt. Please plan ahead for Scouts who are growing fast! Camp is in June so a larger shirt size may be needed!
Special Food Needs *
Some special food accommodations may be possible. There is a possibility that a medical professional note might be required to show a medical need for special food requirements. Please check any special needs. We will contact the camp to check on availability.
Required
MEDICAL and MEDICATION INFORMATION
It is very important that trip leaders are informed of any medical items or prescriptions.

• Medications, both prescription and over-the-counter, MUST be in the original containers. Pill organizer boxes are NOT allowed. Please bring the smallest, travel-size packaging available. Avoid large containers.
• Make trip leaders aware of any medications that require Scout carry such as EpiPens or inhalers.
• For the safety of all Scouts, medications must be presented to the trip leader.

• ALLERGIES - plants may be blooming in South Dakota. If you have hay fever allergies in the summer, you may want to bring the appropriate medications on this trip.
Medical Information - Important *
Medication, Life-Threatening Allergies. NOTE: Scouts are encouraged to bring duplicate emergency medications such as rescue inhalers and EpiPens. One to carry when out of camp and one to keep at the medical office as an emergency backup.
Required
Medical - Other General Information
Other medical information for trip leaders.
BSA Medical *
BSA requires that all Scouts and adults attending camp must have BSA Annual Health and Medical Record that has been signed by a medical professional in the 12 months preceding camp. Links to more information, blank forms and current troop record of your medical form status can be found on the troop Website via this link <http://bit.ly/37vZrYq>. CHECK ALL THAT APPLY. Contact Barb Allan <barballan171@gmail.com> if you have questions.
Required
Program Sign Up
Medicine Mountain runs both a traditional summer camp merit badge program AND a high adventure program.

There is a $75 additional cost for each high adventure program module.
NOTE - it IS possible for Scout age 14 and above to participate in either:
(Option A): One high adventure module and the merit badge program; OR
(Option B): Two high adventure module. If you choose two high adventure modules, there is no room
for merit badges.

Remember, the High Adventure option is only open to Scouts who will be age 14 or above at the time of camp.

SPECIAL NOTE FOR TAILS and DUST Mtn. Biking - evening program ($20 each night). This does NOT interfere with daytime block merit badges.
Program - Scouts age 10 - 13
Important - this is just a BEST GUESS initial choice. We will discuss this further and Scouts may to change their choice after we have meetings. There will be a different form to actually register for Hawk classes and for merit badges. HAWK program is for Scouts working on rank advancement.
Program - Scout age 14 and above
Open to Scouts age 14 and above. IMPORTANT: We cannot register for any high adventures until you are paid in full! Classes fill fast so please pay asap.
Caving High Adventure Choice
Open to Scouts age 14 and above. Spelunking High Adv. (Caving)
Rock Climbing High Adventure Choice
Open to Scouts age 14 and above. New Heights High Adv. (Natural Rock Climbing)
ATV High Adventure Choice
Open to Scouts age 14 and above. Trails & Dust High Adv. (ATV)
Mtn Biking High Adventure Choice
Wheels & Gears High Adventure. Open to Scouts age 14 and above. IMPORTANT: Mtn. Biking is an evening bike ride. It does NOT interfere with either merit badge classes or other High Adventure classes. Wheels & Gears High Adv. (Mountain Biking) $20 each evening ride. ENTER THE NUMBER OF EVENING RIDES YOU WOULD LIKE TO DO (estimate only)
Adult Availability
Please check here if you can attend either part or all of the week. Check all that apply
Adult Level of Certainty
If this form is for an ADULT how certain of you about attending Medicine Mountain Scout Ranch in 2021?
Clear selection
TRIP REQUIREMENTS FOR ALL SCOUTS AND ADULTS
* Medicine Mountain Scout Ranch is open to all Scouts registered in Troop 171G or Troop 171B.

* All Scouts AND adults must have a complete BSA Annual Health and Medical Record (Parts A, B, and C) on file with the Troop.

* BSA Requires that all Scouts and adults attending summer camp must have an up-to-date physical signed within the 12 months preceding camp.

http://www.scouting.org/filestore/HealthSafety/pdf/680-001_ABC.pdf is the current form. Older BSA forms or School and doctor provided forms CANNOT be accepted. <-------------------

• Full details regarding BSA Medical Exam Requirements can be found at
http://www.scouting.org/scoutsource/HealthandSafety/ahmr.aspx

* All adults attending Medicine Mountain Summer Camp MUST be registered with BSA and have completed Youth Protection Training (YPT)

* Adult Training/Certification Summary.
- Complete BSA Annual Health and Medical Record (Parts A, B, and C) signed within 12 months of camp [required]
- Youth Protection Training [required]
- Registration with BSA [required]

- First Aid Certification [strongly encouraged]
- BSA Safety Afloat Training [strongly encouraged]
- BSA Safe Swim Defense Training [strongly encouraged]
- BSA Severe Weather Training [strongly encouraged]
Other Comments
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