2005 � 2006 Registration
Please Submit with the annual fee of $40 per scout, payable to �Cub Scout Pack 65, BSA�
Scout 1 Scout 2 (if Applicable)
Name: ________________________________ Name: ________________________________
Address: _____________________________ Address: ______________________________
_____________________________ ______________________________
Phone: ____________________________ Phone: _______________________________
Date of Birth: ______________________ Date of Birth: ___________________________
School Attended: ______________________ School Attended: ________________________
Check One: Check One:
_____ New Registration _____ New Registration
______ Re- Registration _____ Re-Registration_
(Member of 65 Last Year) (Member of 65 Last Year)
Shirt Size: S M L XL Shirt Size: S M L XL
Parents Names: ____________________________
____________________________
Parents Email: ____________________________
Because Pack 65 Program depends entirely upon the efforts of volunteers, it is important that each family participate by volunteering to serve in at least one of the following capacities: Please select three activities that you would be willing to assist in. We will try to call on you no more than once this year.
_____ Assistant Cubmasters _____ Den Leaders, Assistant Den Leaders
_____ Tiger Cub Coordinator _____ Outings (Camping Trips, Hikes)
_____ Special Events (Pinewood Derby, Cubmobile Races) _____ Pack Committee
_____ Registration and Membership _____ Fund Raising
_____ Blue and Gold Banquet _____ Communications
Volunteer Names: ___________________________ Phone:_____________________
Please Return Completed form with payment to : Ms. Dina Ruggiero
347 Bellevue Avenue
795-5819