Boy Scout Winter Blast Information Guide December 26 – 31, 2016
North Florida Council, BSA 521 S. Edgewood Avenue Jacksonville, FL 32205 www.NFCscouting.org
Camp Shands 1453 Baden Powell Road Hawthorne, FL 32640 www.CampShands.org
Carrie Kurtz, North Florida Council Camping Secretary,
[email protected] Eli Rivera, Camp Shands Director,
[email protected]
DATES & DEADLINES EARLY REGISTRATION FEE TABLE DATE FEE BY NOVEMBER 18, 2016 $215.00 per Scout $80.00 per Adult REGULAR REGISTRATION FEE TABLE DATE FEE AFTER NOVEMBER 18, 2016 $255.00 per Scout $100.00 per Adult
PAYMENTS • Payments are payable to NFC, BSA, 521 S. Edgewood Avenue, Jacksonville, FL 32205. [Do not send Payments to camp.] • Online payments are also accepted. Go to www.nfcscouting.org/winterblast. • Payments must be received to the NFC Service Center on or before (or postmarked by) the dates indicated above. REFUNDS & TRANSFERS • All refund requests must be made by email to Carrie Kurtz, Camping Secretary, at
[email protected]. • Refunds will be given under these percentages and dates: o 80% until November 25, 2016 o 50% from November 26, 2016 to December 9, 2016 o No refunds after December 10, 2016 except for the death of an immediate family member or serious illness (doctor’s note required). o No refunds will be given over 80% in any case. • Fees are transferable to another Scout in the same troop. ADULT LEADER COVERAGE & FEES • 8 or more Scouts attending – 1 FREE leader • Adult leadership may swap out however there is an additional fee of $30 if the new adult wants a patch and hoodie.
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CONTACT INFORMATION www.NFCscouting.org
For Registration, Payments, Billing, & Food Allergies: North Florida Council 521 S. Edgewood Avenue Jacksonville, FL 32205 Carrie Kurtz, Camping Secretary
[email protected] 904-265-3801
(Food allergies must be disclosed at least 2 weeks in advance so we can make accommodations)
For Program, Trading Post, or other questions: Eli Rivera, Camp Director
[email protected] 352-484-7681
Camp Shands:
Ames Administration Building (12/26 – 12/31 only) 352-475-5080 (main line) www.CampShands.org
To send US Mail to a Camp Shands camper: Scout’s Name & Troop # Camp Shands 1453 Baden Powell Road Hawthorne, FL 32640
[NOTE: mail should be sent early enough so it will arrive during camper’s stay in camp.]
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POLICIES & PROCEDURES MEDICAL INFORMATION Every Scout and Adult must submit a completed and current BSA Annual Health & Medical Record form in order to attend camp; no exceptions. Parts A, B & C must be complete. Wi-Fi Adult leaders will find Wi-Fi available at the Ames Administration Building, Meninak Lodge, Leaders Lounge, and Taylor Dining Hall. SHOWER HOUSES & BATHROOMS Please be good to our Shower Houses. Always remember to leave things “better than you found it.” In addition to each person doing their part, a duty roster will be posted which assigns troops the task of cleaning shower houses. A Scout is clean! Do your best! DIETARY RESTRICTIONS We try to accommodate to common dietary restrictions, but in some cases, the participant may need to bring their own food. Any special requests should be communicated via email to camp director, Eli Rivera at
[email protected]. SCOUTMASTER & ADULT LEADERS A Scout is HELPFUL … All adults will be asked to mentor and support provisional Scouts. Any adult that has a special skill may apply for staff (and save the fee) by contacting Eli Rivera, staff spots are not guaranteed. VISITORS & GUESTS All visitors must sign in at the Ames Administration Building upon arrival at camp. This is for the safety of our camp. Guests may eat with us ($4.00 breakfast, $5.00 lunch, and $6.00 dinner). Please notify us at the Ames Administration Building so we may be prepared. Upon departure all visitors are required to sign out, too. TRADING POST Camp Shands has a trading post supplied with all sorts of items such as merit badge books, literature, shirts, hats,
patches, snacks, and soft drinks. Most Scouts will spend on average $40 to $50 during their stay. We accept all major credit cards. PARKING & VEHICLES IN CAMP Carpooling is highly encouraged! All vehicles must remain on the main roads and park in designated areas. You may drive to the campsite to unload / load however vehicle must be moved within 30 minutes. Troop trailers are welcome to stay in campsites. The speed limit is 14 mph and no persons are permitted to ride in the back of vehicles such as trucks or trailers. CAMPERS WITH DISABILITIES Any special accommodation request must be made by email to Carrie Kurtz, camping secretary, at
[email protected]. Camp Shands will do its best to assist with special needs. CHECK-IN The camp staff will be prepared to check-in at 10:00 a.m. on Monday, 12/26. Lunch will be served at 11:45 a.m. and merit badge classes will begin after lunch. CHECK-OUT Breakfast on Saturday morning is a continental breakfast for pick up at the Taylor dining hall at 7:00 a.m. Units should be packed and ready to depart by 8:45 a.m. at the latest. We urge parents to please be on time. We will do a final inspection of the campsite. Scoutmasters Paperwork Pickup (at Ames Admin Building): • Pick up advancement packets, please review your paperwork carefully. Program Director will be available from 7:00 a.m. to 8:30 a.m. to answer any questions you may have. • Pick up patches.
Camp Shands 6th Annual 6k & 1-mile Fun Run Join us on Friday afternoon for the 6th Annual Winter Blast 6k & 1-mile Fun Run. You can register using the special race registration form. Cost for Scouts, Scouters, and their families is only $20 if paid by 12/16/16 which includes a special air dry shirt. You may also show up and run the race for free (shirt not provided). Recognition at the New Year’s Party with amazing awards to be provided. 4
WINTER BLAST SCHEDULE TIME 7:00 7:45 8:00 8:45 9:45 10:45 11:45 12:15 12:30 1:30
MON, 12/26
Check-In
2:30 3:30 5:00 5:45 6:00 7:00
WED, 12/28
THU, 12/29
Breakfast (A) Flag Ceremony Breakfast (B) Merit Badge Period 1 Merit Badge Period 2 Merit Badge Period 3 Lunch (A) Assembly Lunch (B) Merit Badge Period 4 Merit Badge Period 5 Merit Badge Period 6 Dinner (A) Flag Ceremony Dinner (B)
CPR
7:30 Campfire 8:15
TUE, 12/27
Bling Out Hiking Stick Life to Eagle Presentation Night Swim
Vespers
Movie Night
Chess Tournament Night Hike STEM Presentation
FRI, 12/30
SAT, 12/31 Breakfast MB Pick Up Depart
Open Programs
Archery Competition New Year Party
Camp Shands New Year’s Eve Party Friday, December 30th 7:30 p.m.
Competition MERITKaraoke BADGE SCHEDULE Awards Presentation
Countdown into 2016 the Camp Shands way!
1st Period
2nd Period
3rd Period
4th Period
5th Period
6th Period
Search & Rescue
Search & Rescue
Emergency Preparedness
Emergency Preparedness
First Aid
First Aid
Scouting Heritage
American Cultures
Family Life
Fire Safety
Bird Safety
Stamp Collecting
Geocaching
Geocaching
Ultimate
Ultimate
Orienteering
Orienteering
Outdoor Ethics Awareness
Astronomy
Astronomy
Geology
Geology
Trail to Eagle
Fish & Wildlife
Fish & Wildlife
Wacky Science
Wacky Science
Sculpture
Sculpture
Indian Lore
Chess
Chess
Chess
Para Cord Fun
Para Cord Fun
Wood Carving
Wood Carving
Wood Carving
Wood Carving
Digital Technology
Programming
Photography
Photography
Movie Making
Movie Making
Cit in Nation
Cit in Nation
Cit in World
Cit in World
Communication
Communication
Safety
Safety
Cit in Community Personal Management
Cit in Community Personal Management
Public Speaking
Public Speaking
Archery
Environmental Science
GBB (1st year program for Scout, Tenderfoot, 2nd & 1st) Welding
STEM Nova
Personal Fitness
Personal Fitness
Dentistry
Lifesaving
Lifesaving
Lifesaving
Archeology Metalwork (blacksmithing)
Animation
Archery Electronics
STEM Nova
Electronics
Automotive Maintenance
Aviation Swimming
Dentistry Swimming
Home Repairs
Swimming Painting
Metalwork (blacksmithing)
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AT-A-GLANCE SPECIAL PROGRAMS Monday, 12/26 • • • • •
Swimming Water Rescue @ 1:30 p.m. Flag Ceremony @ 5:45 p.m. CPR Training @ 7:00 p.m. Opening Campfire @ 7:30 p.m. Scoutmaster Meeting @ 8:30 p.m.
Tuesday, 12/27 • • • • • •
Swimming Water Rescue continues @ 8:45 a.m. Wilderness First Aid @ 8:45 a.m. Scoutmaster Specific @ 8:45 a.m. Bling out Hiking Stick @ 7:00 p.m. Life to Eagle Presentation @ 7:30 p.m. Night Swim @ 8:15 p.m.
Wednesday, 12/28 • • • • •
Wilderness First Aid continues I.O.L.S. @ 8:45 a.m. Vespers @ 7:00 p.m. Merit Badge Counselor Training @ 7:30 p.m. Movie Night @ 7:30 p.m.
Thursday, 12/29 •
I.O.L.S. continues • 2-Day Leave No Trace course @ 8:45 a.m. • Nap on Safely Training @ 4:00 p.m. • BSA Leave No Trace 101 @ 7:00 p.m. • Chess Tournament @ 7:00 p.m. • Night Hike @ 7:30 p.m. • STEM Presentation @ 8:15 p.m. • Star Gazing Party @ 9:00 p.m.
Friday, 12/30 • • •
2-Day Leave No Trace course continues Polar Bear Plunge @ 1:30 p.m. 6th Annual Winter Blast 6k Run & 1-mile Run @ 3:00 p.m. • Campmaster Training @ 4:00 p.m. • Archery Competition @ 7:00 p.m. • New Year Eve Party @ 7:30 p.m.
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SPECIAL PROGRAMS Red Cross CPR ~ get certified, save a life, you’ll be glad that you did! Cost is only $20 and limited to the first 20 paid participants. Class is open to adults and Boy Scouts. Payments may be made in advance using the special program registration form. Scoutmaster Meeting ~ this is a required meeting for at least one adult to attend per unit. We will cover troop assignments, program information, and emergency procedures. SPL welcome to attend.
6th Annual Winter Blast 6K Run & 1-mile FUN RUN ~ join us for an amazing 6K & 1-mile fun run. Cost for Scouts, Scouters, and their families is $20 if paid by 12/16/16. Each participant gets a special air dry shirt.
Wilderness First Aid ~ current CPR certification is required and
all participants must be at least 14 years of age. Cost is $95.00 if attending Winter Blast. Non Winter Blast participants may purchase meals separately as there is not time to run to town. NOTE: Boy Scouts do not have time to attend this session and take merit badge classes. Participation is limited to the first 10 paid participants. Camping is available. Payments may be made in advance using the special program registration form.
Winter Blast participants may purchase meals separately as there will not be time to run into town. NOTE: Boy Scouts do not have time to attend this session and take merit badge classes. Participation is limited to the first 10 paid participants. Payments may be made in advance using the special program registration form.
BSA Leave No Trace 101 ~ this course is a general introduction to the Leave No Trace ethics and skills to those with minimal prior exposure. The course is designed to help youth and adults at all program levels understand the general principles of Leave No Trace and how to apply them in the general BSA outdoor program. It is also designed to give adult volunteers the confidence to assess youth understanding and skills for purposes of signing off on Boy Scout Second Class and First Class rank requirements. A BSA Leave No Trace Awareness card will be presented upon completion. Free class and no sign up is required. Swimming Water Rescue ~ want to be able to take your unit on swimming outings? Take this class to learn about safe swim defense, safety rescues and have fun while doing it. Participants must be at least 16 years of age and must assist with one pool dinner party. Cost is $7.00 which includes a patch.
Scoutmaster Specific ~ this course is intended to provide troop
Chess Tournament ~ do you have the skills to be the chess
Campmaster Training ~ ever wanted to be a Campmaster? Do
Night Swim ~ come join us at our brand new aquatics center to
leadership with the information and tools needed to lead successful Boy Scout troops. This is a one-day free course.
you have a love for Camp Shands? Campmaster’s are the key to weekend camping and we’ll explain why, what the role of a Campmaster is, and how to volunteer within Camp Shands. Free class!
Life to Eagle Presentation ~ this seminar is designed to give a
Scout the information and procedures he needs to have the opportunity to successfully advance to the rank of Eagle Scout. This is a must for Life Scouts that desire and plan to earn the Eagle Scout rank. This seminar is open to all Boy Scouts, leaders and parents (even if not attending Winter Blast)
Bling out Hiking Stick ~ come bling out your very own hiking
stick. Our knowledgeable staff will be available to customize and decorate your own hiking stick. We will also have staff available to brand (or mark) your hiking stick, belt, or hat.
STEM Presentation ~ do you want more information about
master? Join us in the Meninak and play against our chess masters! Awards will be presented at New Year Party.
enjoy an evening of swimming including 2 brand new slides and splash pad.
Night Hike ~ check your batteries and get your flashlight ready for an evening hike on a brand new trail at camp. Bring your water bottle and be prepared to walk!
Star Gazing Party ~ do you love the stars? Always wanted to
know where the Big Dipper is? Our trained staff will show off the sky.
Pool Dinner Party ~ do you want to eat and swim at the same time? Sign up your troop for dinner at the aquatics center and our staff will bring you everything you need to prepare your dinner. Limited days. Choice of hamburger and hot dog dinner (no extra fee) or for a small fee have pizza delivered ($8 per pie).
a great movie. Anyone taking Citizenship in the Community this will meet one of the requirements.
Polar Bear Plunge ~ in the spirit of winter, Camp Shands will present the annual dip of the Polar Bear Plunge for Scouts and adults that are willing to brave the cold for a brief dip in the lake. Be sure to bring towels and warm clothing to change into. Many Polar Bear swimmers dress in costumes! Remember a permission slip must be on file in order to take advantage of this great activity.
IOLS (Introduction to Outdoor Leader Skills) ~ working as
Nap on Safely ~ learn how to take a proper nap led by trained
STEM? Are you working towards a NOVA or SUPERNOVA award? Join us as we explain all this and more. Ice cream will be provided too!
Movie Night ~ join us in the Meninak Lodge to relax and enjoy
patrols, this hands-on course provides adult leaders the practical outdoor skills they need to lead Scouts in the out-of-doors. This course if free and is a 2-day course.
2-Day Leave No Trace Course ~ participants must be at least 14
years of age and cost is $20 for Winter Blast participants. Non
professionals. This is an adult training only and will receive certification upon completion.
Archery Competition ~ are you good with a bow? Award for top archer (presented at New Year Party).
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MERIT BADGE NOTES & FEE’S MERIT BADGE
PRE-REQUISITE
American Culture Animation Archeology
None None None
Archery
None
Astronomy
None
Automotive Maintenance Aviation
None None
Bird Study Chess Citizenship in Community Citizenship in Nation
None None Complete 3, 4, 7 None
Citizenship in World
None
Communication
Complete 5, 8
Dentistry
Complete 3
Digital Technology
Complete Cyber Chip None
Electronics Emergency Preparedness
Fire Safety First Aid
Complete First Aid merit badge None Complete 2, 3, 4 and Complete 5 after camp None None
Fish & Wildlife Mgmt.
None
Environmental Science Family Life
NOTES
Recommended minimum age is 12 years old. Participate in a real dig! Make your own arrow to take home. Must attend evening star gazing party. 2 class period. Permission form required for flight; 2 class period.
ADDITIONAL FEE
$8.00
$10.00 $25.00
Each Scout will receive a chess set. Homework will be required. Recommended minimum age is 13 yrs. old; homework will be required. Recommended minimum age is 14 yrs. old; homework will be required. Recommended minimum age is 13 yrs. old; homework will be required. Req. 3 is to see a dentist prior to arrival.
$9.00
Recommended minimum age is 14 yrs. Old; Each Scout will receive an electronics kit. Recommended minimum age is 12 yrs. old. 2 class period. Develop a plan to complete this badge with your family
$15.00
OPTIONAL: Take Red Cross CPR class.
$20.00 (optional)
GBB
None
Geocaching Geology Home Repairs Indian Lore Lifesaving Metalwork
None None None None Must be First Class or above Complete 2, 4
Movie Making Orienteering Outdoor Ethics Awareness
None Complete 7 None
Painting Para Cord Fun
None None
Personal Fitness Personal Management
Complete 7, 8 Complete 2, 8
Photography Programming Public Speaking
None Complete Cyber chip None
Safety
2b
Scouting Heritage Sculpture Search & Rescue Stamp Collecting
None None None None
STEM Nova
None
Swimming Trail to Eagle
Must pass a BSA swimmers test None
Ultimate Wacky Science
None None
Welding Wood Carving
7a Complete Totin’ Chip
For 1st year Scouts (Scout, Tenderfoot, 2nd & 1st Class rank requirements)
Each Scout will receive a kit. OPTONAL: Take Red Cross CPR class. Recommended minimum age is 13 years old. Course option on Blacksmithing.
$20.00 $20.00 (optional)
Not a merit badge; Patch presented at end of course. 2 class period. Not a merit badge; learn fun uses of para cord.
$4.00 $10.00
Finish your budget and weekly schedule prior to camp.
Recommended minimum age is 13 yrs. old. Bring a written copy of family plan escape in case of fire (req. 2b) $7.00 Each Scout will receive their own set of stamps. Work with counselor to get on target for award. Work with counselor to prepare a written plan for Eagle. Each Scout will receive a Frisbee. Not a merit badge; have fun doing experiments daily. 2 class periods. Each Scout will receive a kit including a whittling knife.
$25.00
$10.00 $5.00 $15.00 $22.00
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DIRECTIONS TO CAMP www.CampShands.org 1453 Baden Powell Road Hawthorne, FL 32640
From South Jacksonville: • BLANDING BLVD (FL-21) South • Continue to MEROSE on FL-21 • LEFT onto BADEN POWELL ROAD • Arrive at camp for your Scouting Adventure! From North Jacksonville: • I-10 WEST to LAKE CITY • Take EXIT #343 onto US-301 towards STARKE • LEFT onto FL-26 • RIGHT onto FL-21 • LEFT onto BADEN POWELL ROAD • Arrive at camp for your Scouting Adventure!
• • • • •
From Gainesville: EAST UNIVERSITY AVENUE SLIGHT RIGHT onto FL-20 (SE HAWTHORNE ROAD) LEFT onto FL-21 RIGHT onto BADEN POWELL ROAD Arrive at camp for your Scouting Adventure!
PERSONAL GEAR TO BRING TO CAMP Long-sleeve shirts Pillow Personal first aid kit Pants Socks Flashlight, batteries Wallet, money Underwear Jacket Notebook and pen Sweatshirt / hoodie Scout handbook Rain gear Merit Badge books Bug repellant Sleep wear Water bottle Sneakers Hiking boots Sun screen lotion Toilet items (soap, shampoo, toothbrush, Scout uniform tooth paste, deodorant, and hair brush) Dry pack to carry items Sleeping bag or blankets DON’T FORGET TO LABEL ITEMS WITH NAME AND TROOP NUMBER 11
Winter Blast 2016 Individual or Troop Form To register use this form or register on-line at www.nfcscouting.org/winterblast
Mail form along with payment to: North Florida Council, 521 Edgewood Ave. S., Jacksonville, FL 32205
If paying for multiple youth and/or adults use this form and the unit roster. If paying for an individual, please put participant name under name below.
Name: ________________________________________________
Troop: ___________
Email _________________________________________________ Phone: ________________________________________________ _______
Boy Scouts @ $215 by 11/18
=
$_____________
_______
Boy Scouts @ $255 after 11/18
=
$_____________
_______
Boy Scout Adults @ $80 by 11/18
=
$_____________
_______
Boy Scout Adults @ $100 after 11/18
=
$_____________
_______
Boy Scout Adults @ FREE
=
$_____________
_______
Hoodie & Patch (extra) @ $30 each
=
$_____________
Total Amount Enclosed
$_____________
Total Hoodie Sizes (hoodies tend to run small) YM YL
__________ __________
Payment Method: Cash
AS AM AL Check*
__________ __________ __________ Visa
MasterCard
AXL 2XL 3XL
__________ __________ __________
Discover
Amex
Make check payable to: North Florida Council, BSA *When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction.
Credit Card Information: Name as it appears on card: ____________________________________ Zip Code: __________ Credit Card # ___________________________ Exp. Date: __________ 3-4 Digit Code: _____ Signature for Authorization: _____________________________________ Note: By submitting a registration form, you are authorizing the North Florida Council, BSA to take photos of your Scout and family for promotional purposes ONLY. Photos will not be sold or utilized for any use outside of youth and volunteer recruitment by the North Florida Council, BSA.
Event Code: 172
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Winter Blast 2016 Special Program Registration Form Special programs are registered separately from regular registration. You do not have to attend Winter Blast Resident Camp to attend these special programs. Classes will be filled on first paid, first served. NOTE: Non-Winter Blast participants may purchase meals at camp. (Breakfast $4, lunch $5 and dinner $6) To register use this form or register on-line at www.nfcscouting.org/winterblast Name: ________________________________________________ Troop: ___________ Email _________________________________________________ Phone: ________________________________________________ _______
Red Cross CPR @ $20
=
$_____________
_______
Wilderness First Aid @ $95
=
$_____________
_______
2-Day Leave No Trace @ $20
=
$_____________
_______
Meals (Breakfast $4/Lunch $5/Dinner $6)
=
$ _____________
Total Amount Enclosed Payment Method: Cash
Check*
$_____________ Visa
MasterCard
Discover
Amex
Make check payable to: North Florida Council, BSA *When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction.
Credit Card Information: Name as it appears on card: ____________________________________ Zip Code: __________ Credit Card # ____________________________ Exp. Date: __________ 3-4 Digit Code: _____ Signature for Authorization: ____________________________________
Note: By submitting a registration form, you are authorizing the North Florida Council, BSA to take photos of your Scout and family for promotional purposes ONLY. Photos will not be sold or utilized for any use outside of youth and volunteer recruitment by the North Florida Council, BSA.
Event Code: 172
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Polar Bear Plunge Permission Slip
I, ________________________________________ am the _____________________________ (Parent or Guardian Name)
(Relationship to Scout)
of Scout ________________________________________. I give permission for my son to (Scout’s Name)
Participate in the Polar Bear Plunge during Winter Blast 2016 and to earn his Polar Bear Plunge Patch. _________________________________________________ (Parent or Guardian Signature)
I, _______________________________________ am the Scoutmaster of the above Scout (Scoutmaster’s Name)
from Troop ______ and I certify that he has passed the 1st Class Swim Test in the last 6 months. ____________________________________________________ (Scoutmaster’s Signature)
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Field Trip Permission Slip I, __________________________________________, give permission for my son (Parent/Guardian’s Name)
__________________________________ to leave Camp Shands as needed for his merit badge class under the supervision of registered adult volunteers. I understand that this will entail transportation in the volunteers personally owned vehicle which will be occupied by other adult leaders and Scouts. Parent Name (print): ___________________________________________________________ Parent/ Guardian Signature: _____________________________________________________ Date: __________________________
******************************************************************************
For the Aviation Merit Badge please give additional consent I understand the Aviation Merit Badge will also include an orientation flight once they reach the airfield. I further give permission for my son to participate in these activities. Parent/Guardian Name (print): __________________________________________________ Parent/Guardian Signature: _____________________________________________________ Date: __________________
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Metalwork Merit Badge Blacksmith Workshop – Release of Liability SUPPLEMENTAL CONSENT TO PARTICIPATE IN METALWORK MERIT BADGE BLACKSMITHING OPTION AND ACKNOWLEDGEMENT OF RISKS: I/we hereby acknowledge that participating in Metalwork merit badge with the option of Blacksmithing involves a risk of injury including but not limited to the following: heat or fire injuries, accidents involving hot or molten metal, fire and hammer blows. I accept and assume these risks in giving consent for the undersigned Scout to participate in such activities, understanding that certain risks simply cannot be eliminated without jeopardizing the essential qualities of the program. Although our program has worked to minimize these risks, some are inherent in the craft of blacksmithing. I understand the instructors and other adults involved in this activity will exercise due caution and care and if a misfortune or accident occurs, it will be addressed and managed promptly and responsibly. I release and hold harmless the North Florida Council, Camp Shands, its agents, employees, and officers from any and all actions, or causes of actions of any nature for personal injury and property damage of any kind arising in a way from my child’s participation in Metalwork with the option in Blacksmithing. Scouts Name: __________________________________________________ Age: __________ Parent/Guardian Name (print): __________________________________________________ Parent/Guardian Signature: _____________________________________________________ Date: _____________________________
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WINTER BLAST 6K RUN or 1 MILE FUN RUN GET SAND IN YOUR SHOES Friday December 30, 2016 Registration 7 am - run starts 7:30 am Camp Shands on the Baden Powell Scout Reservation 1453 Baden Powell Road Hawthorne, FL Open to the General Public, Scouts and Scouters Cost $30 for Scouts, Scouters and Scout families Cost $35 general public Fee includes an air dri-tech t-shirt REGISTER BY DECEMBER 18th AND SAVE $5/PERSON Special plaque for under 21 years old and 21+ winners Age group prizes: (both male & female) 10 and under, 11-15, 16-21, 22-30, 31-40, 41-50, 50+
This challenging course will travel 6 kilometers over varied terrain over sandy roads so wear appropriate shoes. We will run rain or shine or cold
Register by using form below or online at www.nfcscouting.org/winterblast6k Tear off this bottom portion to submit with your registration payment. Save the top portion for your records. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
REGISTRATION FORM FOR Winter Blast 6K and 1-mile fun run SUBMIT COMPLETED REGISTRATION FORM TO: The North Florida Council, 521 S. Edgewood Avenue, Jacksonville, FL 32205
Name of Participant: __________________________________________________ E-mail Address: ______________________________ Phone: _________________ Amount Paid
______$20 ($30 after 12/18) Scouts, Scouters & Scout Families ______$25 ($35 after 12/18) for general public
Which Course would you like to run: 1-Mile Fun Run ____
6K Run _____
T shirt Size: YM__ YL__ AS__ AM__ AL__ XL__ 2XL__ 3XL__ 4XL__
Check* MasterCard Visa Discover AmEx Method of payment: Cash Make checks payable to The North Florida Council *When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction.
Credit Card Payment Name as it appears on Credit Card: _____________________________ Zip Code: ____________ Credit Card Number: _______________________ Expiration Date: _________ 3-Digit Code: ____ Signature for Authorization: ________________________________________ Note - By submitting a registration form you are authorizing the North Florida Council, BSA to take pictures of your Scout for promotional purposes only. Photos will not be sold or authorized for any use outside of youth and volunteer recruitment by the North Florida Council, BSA.
Event Code: 172 17