You don’t want to miss the premier ADULT LEADERSHIP DEVELOPMENT COURSE for the 2018

Wood Badge helps adult leaders deliver the highest quality program to young people, so that the Scouts can achieve their highest potential. LDS Leaders who should consider taking this course are: 1) Young Men Presidencies (including advisors) 2) , Boy Scout & Leaders 3) Bishoprics 4) Primary Presidencies 5) Scout Committee Members 6) Stake Leaders • Complete Basic Training for the primary Position in Scouting • Capable of functioning in an outdoor environment • Have a current Medical Form Parts A, B and C (Physical must have been completed since April 2016)

The dates for S4-87-18-2 Location: Thursday, February 22, 7:30 am - Saturday, February 24, 5:00pm Camp Shands at Baden Powell Scout Reservation Thursday, March 22, 7:00am – Saturday, March 24, 5:00pm 1453 Baden Powell Road, Hawthorne, FL 32640

The cost for the course is $210. A minimum deposit of $25 is due with the application. The participant portion of the course fee is $95.00. The Stakes will contribute $25 per participant, and we will offset the last $90 by “gift-in‐kind” donations of food. Includes food, camping fees, program materials, insurance and administrative costs. Make all checks payable to NFCBSA with “S4-87-18-2 Wood Badge 2018” in the memo section. All fees must be paid by January 14, 2018. Attendance Qualification: The Wood Badge training course is available to Scout Leaders of all programs who have completed Youth Protection Training and the basic training course and outdoors skills training relevant for their Scouting position. Medical Information: All participants must have a current BSA Annual Health and Medical Records Parts A, B, and C form to participate in the Wood Badge course. Course participants will be asked to participate in some limited hiking, backpacking and outdoor activities. NOTE: Payments, excluding a $25 non-refundable administrative fee, are refundable in case of cancellation if requested by January 14, 2017. After this date, refunds can only be made for hardship reasons, and should be discussed with the Scoutmaster/Course Director as soon as the hardship becomes known. How to Apply: Complete the Wood Badge Registration form located on the other side of this form. The completed application, along with a non-­‐ refundable $25.00 deposit should be taken to your LDS Stake Scouting Coordinator, friendly staff member, or mailed to: North Florida Council – BSA, Attn: Customer Service – Wood Badge 521 So. Edgewood Avenue, Jacksonville, FL 32205 EVENT CODE 043

For more information on Course S4-87-18-2 contact Course Director, Craig Herrington at [email protected] Wood Badge 2018 Registration Form S4-87-18-2

I am submitting this registration form to express my intentions of participating in the Wood Badge Course, S4-87-18-2, being held at Camp Shands February 22-24 and March 22-24, 2018.

I understand that attendance at all sessions is mandatory and is required for certification. I have completed (or will have completed prior to the course) the Youth Protection Training and the basic training and outdoor skills training that is relevant for my position in Scouting, and I am a registered adult leader.

Statement of Medical Health: I understand that my participation in a Wood Badge course is contingent upon submission of a BSA Annual Health and Medical Record Parts A, B, and C. Medical approval is required for hiking, backpacking and outdoor activities.

Signature: ______Date: ______

(Please print or type the following)

Name: ______Gender: Male ____ Female___

Address: ______

City/State/Zip: ______

Home Phone: ______Cell Phone: ______Work Phone: ______

Email Address: ______Alt Email: ______

District: ______Council: ______

Unit Type: Troop ___ Pack ___ Team___ Crew___ District___ Council___ Unit Number: ______

Primary Scouting Position: ______Years in Scouting: ______

Scouting Awards: ______

Completion Dates of Required Training: Youth Protection: ______Position Leader Specifics: ______Outdoor Leader Skills (if applicable): ______

Occupation: ______Employer: ______

T-Shirt Size: AS ___ AM ___ AL ___ XL ___ 2XL ___ 3XL ___ 4XL ___

A $______deposit ($25 minimum) to hold my place in the Wood Badge course is enclosed. If I am unable to attend, and if I notify the North Florida Council Service Center at least 30 days before the opening of the course, all monies (except a $25 administrative fee) will be refunded. The total participant fee of $95.00 MUST be paid by Monday, January 14, 2017. The total course fee is $210.00 (subject to change).

Method of Payment: 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.

Name on Credit Card: ______Zip Code: ______CC#: ______Expiration 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 or video footage of your Scout and family for promotional purposes ONLY. Photos and video will not be sold or utilized for any use outside of Event Code: youth and volunteer recruitment by the North Florida Council, Boy Scouts of America. 042