LaSalle NYLT 2012 Application Form

July 8 – 14, 2012

Camp ToPeNeBee

Name __________________________ Home Phone (______)_____-______

Address ________________________ Date of Birth _____ / ______ / ______

City ____________________________ State ____________ ZIP ___________

e-mail __________________________

Troop _____________ Rank _________ Leadership position _______________

I want to attend LaSalle NYLT 2012. In signing this form I agree:

1. I am or will be at least 13 years old by the first day of LaSalle NYLT 2012.

2. I presently hold or will hold a leadership position in my troop.

3. I understand acceptance to this course is on a “first come, first served” basis.

4. I have ___ (have not __) completed Troop TLT leadership training Course and

have a Trained patch on my uniform. CLT (Crew Leadership Training)

Scout Signature ______________________________________

T-shirt size: (circle) S M L XL XXL XXX

As the Parent of this Scout:

1. I give my permission for and support this training.

2. I understand the $50 Interest Fee is non-refundable.

3. I understand the total cost is $220 (including Interest Fee).

After May 30, 2012, cost is $250.

4. Complete and return this form to LaSalle Council Office by May 30, 2012.

Parent signature ______________________________________________

As the Scoutmaster for this Scout:

1. This Scout fulfills the requirements for entry into this course.

2. This Scout will be at least 13 years old, First Class rank, and is expected

to be in a leadership position in my troop (crew).

3. I give permission for LaSalle NYLT 2012 to train this Scout.

SM (CL) Signature ________________________ Name _________________

Address __________________ City __________ State ____ ZIP _________

Phone __________________________ e-mail __________________________________

                                                                                                        Event Number 471