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<strong>Outdoor</strong> <strong>Program</strong> <strong>Equipment</strong> <strong>Checkout</strong> <strong>Form</strong><br />
Please allow 6-8 weeks for processing<br />
Type of Camp: Day Camp Service Unit/Cluster Council Troop # Other<br />
Number of Participants: Girls Adults PA Other Total Attendees<br />
Name<br />
Mailing Address<br />
Physical Address<br />
City/State/Zip<br />
Day Telephone Number<br />
Emergency Number<br />
Evening Telephone Number<br />
E-mail Address<br />
The following items for outdoor camping must be picked up at the Council Service Center or Council-owned camp. If the troop/group is doing<br />
<strong>Outdoor</strong> Cooking or Troop Camping, someone with the group must have council approved training.<br />
Items Being Requested<br />
Upon <strong>Checkout</strong> Note Any Unsatisfactory Conditions<br />
Number of Item* Item Number Upon Check-Out Upon Check-In<br />
Coleman stoves (fuel not included (1)<br />
Stands for Coleman stoves (1)<br />
10” Dutch ovens w/lid (1)<br />
12” Dutch ovens w/ lid (1)<br />
14” Dutch ovens w/lid (1)<br />
8” Iron skillets (1)<br />
10” Iron skllets (1)<br />
12” Iron skillets (1)<br />
Ice chests (3)<br />
Water coolers (2)<br />
Battery lanterns (batteries not included)(4)<br />
Kerosene lanterns (fuel not included)(2)<br />
Tents, nylon cabin (9x12)<br />
Tents, canvas roundup (9x9) floored<br />
Tents, canvas roundup (9x9) non-floored<br />
Kitchen fly (___Cloth___ Plastic)(2)<br />
Dishpans (3 per Troop/Group) Long-handled toasting forks (6) Hoes (1)<br />
Pie irons (6) Mallets (1) Tin snips (1) Rakes (1)<br />
Brooms (1) Buckets (1) Shovels (1) Other<br />
Pots, indoor use or Coleman stove (2) Small Medium Large<br />
Cooking pots, for use over open flame (wood/charcoal) Small Medium Large<br />
Cook kit (2 hot mitts, 1 slotted, 1 non-slotted spoon, spatual, & tongs)(1)<br />
*Please note maximum amounts allowed in parenthesis. All tents are 1 for four people.<br />
If additional quantities are needed, please describe circumstances for additional requested items.<br />
Person with <strong>Outdoor</strong> Cooking/Overnight Camping Training
Certification Date<br />
Games And Sports <strong>Equipment</strong><br />
Volleyball sets Softballs Softball bats<br />
Badminton sets Playground balls Hula hoops<br />
Tininkling poles<br />
Pair(s) Lummi Sticks<br />
SPECIALITY EQUIPMENT<br />
Certified or trained personnel must be present for use of the following equipment. You will need to submit the name of the person responsible<br />
for the use of the equipment and a copy of their credentials showing date certification was issued and expiration date when submitting this<br />
request. Some items may not be available due to transportation limitations.<br />
Canoes Paddles Life jackets Bows<br />
Arrows Arm guards Finger tabs Finger guard<br />
Backpacking stoves Backpacks Windscreens Gloves<br />
Backpacking nesting pots Dome tents Bicycling helmets Riding helmets<br />
(Horseback)<br />
Funnoes (Camp Sandy Bend and Camp Rocky Ledges)<br />
Other<br />
Name of adult supervising this equipment<br />
Date of Certification<br />
Date of Expiration<br />
Notes on condition/cleanliness of equipment<br />
Upon Check-Out<br />
Note any repairs needed (tag appropriate equipment)<br />
Upon Check-In<br />
I understand that I am responsible for the items listed as borrowed on this sheet. All items will be returned cleaned and in satisfactory condition,<br />
within 1 week of event or activity.<br />
Signature<br />
Pick-up location<br />
Date of pick-up<br />
Date<br />
Date of return<br />
PRO-67 (08/10)
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