CSR 2019 | Day Camper Registration Week 4 (July 8-12)
Use this form to register for the Provisional Unit at Cherokee Scout Reservation.

The Provisional Unit is open to female and male Scouts.

Scout Information
Scout's First Name *
Your answer
Scout's Last Name *
Your answer
Scout's BSA ID
Your answer
Scout's Date of Birth *
MM
/
DD
/
YYYY
Scout's Gender
Your answer
Scout's Unit Type *
Scout's Unit Number *
Your answer
Scout's District Name
Your answer
Scout's Council Name *
Your answer
Parent/Caretaker Information
Parent/Caretaker 1's First Name *
Your answer
Parent/Caretaker 1's Last Name *
Your answer
Parent/Caretaker 1's Cell Number *
Your answer
Parent/Caretaker 1's Email Address *
Your answer
Parent/Caretaker 2's First Name
Your answer
Parent/Caretaker 2's Last Name
Your answer
Parent/Caretaker 2's Cell Number
Your answer
Parent/Caretaker 2's Email Address
Your answer
Emergency Contact Information
Please list the name of an emergency contact other than a parent or primary caretaker.
Emergency Contact's First Name *
Your answer
Emergency Contact's Last Name *
Your answer
Emergency Contact's Cell Number *
Your answer
Special Needs Information
In this space please describe any special needs the Scout may have. They might include but are not limited to dietary, medical, physical, or cognitive needs.
Your answer
Unit Leader Information
Please provide the name and email address of your Scout's unit leader. We will use this information to share your Scout's advancement report with the unit. We will email the unit leader a copy of your Scout's merit badge completion report on the Saturday your Scout departs summer camp.
Unit Leader's First Name *
Your answer
Unit Leader's Last Name *
Your answer
Unit Leader's Email Address *
Your answer
Payment Information
You can submit your payment two ways.

The preferred method is to pay using a credit card online. If you select this option, we will send you directions on how to pay using a secure Parent Payment Portal in our merit badge registration system - Summer Camp Systems.

You may also submit a check made payable to Old North State Council.

Or, you can pay in person at the Old North State Council Office.

How do you plan pay? *
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