2012 Camp Constantin, Jack D. Furst Aquatic Base Program Guide

Peddle & Paddle Application
This application is to be submitted by individual participant in Peddle and Paddle. An existing unit reservation
in good standing is required for this application to be considered. Peddle and Paddle has an additional $100 fee
per person; this is in addition to all regularly scheduled camp fees. Spots are filled on a first come first serve
basis.
PLEASE PRINT NEATLY
Existing unit reservation Troop/Crew#: ______ Council: ___________________
Adult submitting troop reservation: _______________________________
Attending week: ___Week 1 – June 10-16 ___Week 2 – June 17-23
___Week 3 – June 24-30 ___Week 4 – July 1-7
___Week 5 – July 8-14 ___Week 6 – July 15-21
Participants Name: ___________________________ E-mail Address: ______________________________
Phone H: _________________ C: ________________ Age on June 3, 2012: ______
Parents Name: ________________________________ E-mail Address: ______________________________
Phone H: _________________ C: ________________ W: ___________________
Address: ______________________________________City/State/Zip: __________________________
You will receive a confirmation e-mail when your application has been accepted
Send all receipts, confirmations, and additional information to: _____Unit leader listed on reservation
_____Parent’s address listed above
FOR SCOUTMASTER, PARENT/GUARDIAN, and PARTICIPANT:
Peddle and Paddle participants must be registered Scouts and at least 14 years of age. Each participant must be
able to pass the BSA swim test and have a completed copy of the new BSA Annual Health and Medical Record
completed by parents or guardian and supported by a medical evaluation completed within the last 12 months
by a physician licensed to practice medicine. All Scouts in camp are required to have a parental signature in
the “Parental Permission” signature block giving permission to treat in an emergency. Use the current BSA
“Annual Health and Medical Record”.
We have discussed with our Scout the meaning of the Scout Oath and Scout Law. He understands his
responsibility to do his best to follow the Scout Oath and Scout Law during his stay at Camp Constantin, Jack
D. Furst Aquatic Base. We give our permission for the above listed scout to participate fully in the itinerary
listed on page ___of the Camp Constantin, Jack D. Furst Program Guide.
________________________________ ______ ________________________________ ________
Scoutmaster’s Signature Date Parent/Guardian’s Signature Date
__________________________________ __________________________________
Print Name Print Name
Please submit completed form with $100 fee to: Circle Ten Council
$100 fee is refundable if we are unable to accommodate your ATTN: PEDDLE & PADDLE
request due to availability 8605 Harry Hines, Dallas, TX 75235
Please direct all inquiries to Scott Arrington, Camping Director, 214-902-6778, scott.arrington@scouting.org
Revised 2-20-2012
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Camp Constantin, Jack D. Furst Aquatic Base 2012 Program Guide
Updated 4-10-2012