TROOP REGISTRATION FOR Corn Maze 22 Oct 2011

ALL REGISTRATIONS, including FEES, MUST BE RECEIVED BY Oct 20, 2011
After completing this on-line Registration, mail Payment to
Michelle Acosta (adress on confirmation page)
Troops are responsible for bringing individual health history forms and permission slips for all participants.  Troops should bring their own first aider, but their will be one at the site. 
Parents are welcome, but teens (11-17) only please.

This is a Troop Registration    Individual Registration     CASP3R home

Troop Contact Information
Troop #:  Service Unit: Program Level:
First Name:
Last Name:
E-Mail:
Street/PO Box:
City:  
State:

  

Zip Code: 
Day Phone: (999-999-9999)
Eve Phone: (999-999-9999)
Cell Phone: (999-999-9999)
Troop First Aider Name: person attending with troop
First Aider Cell Phone: (to reach at farm, if emergency)

# GIRLS and ADULTS ATTENDING

Number with patches:     x  Fee per person: = $

Number without patches:   x  Fee per person: = $

TOTAL FEE  =  $ Put this amount on your mailed check, made out to "GSCNC"
 
Other Comments: