Pack 501 Information Sheet 2013/2014
Name ___________________________________________________________________Grade___________Den__________________
Address _________________________________________________________________________________________________________
City ________________________________________________________State____________Zip______________________
Home Phone _________________________________________________________Birthday _________________________________
Mother’s Name ______________________________________________________Cell #_____________________________________
Father’s Name _______________________________________________________Cell # ____________________________________
Can you receive TEXT messages by you phone? If so which one____________________________________________
Scouts Cell # __________________________________________________________
If Grandparents or OTHER are the ones that will be brining the scout to meetings please sign their names below.
Name _________________________________________________________________Phone # __________________________________
If Parents are DIVORCED who should we contact with any scout information?
Name _________________________________________________________________Phone # __________________________________
Email Address of Parents ______________________________________________________________________________________
______________________________________________________________________________________
IS there anyone who should NOT pick up your son from scouts? If so _____________________________________
____________________________________________________________________________________________________________________
Do you have a FACEBOOK Page? Yes______no_____ Name _____________________________________________________
Medical Concerns _______________________________________________________________________________________________
Any food he should NOT eat or drink _________________________________________________________________________
In an EMERGENCY CALL ________________________________________________________ @____________________________
Family Members (TOTAL) _______________# Family Members ____________# Brothers #______________Sisters
Teachers Name 2012/2013 school year ______________________________________________________________________
Name of School Circle one : Dover Elementary / North Stewart Elementary / Home School
Cubmaster Signed _________________________________________________________________Date ________________________