Southern Shores Field Service Council BSA

2017 National Youth Leadership Training (NYLT)

Participant Permission Slip

Course Dates: 1PM Sunday, June 25 through 8PM Friday, June 30

Recommended Pre-course Orientation: 9AM – Noon, Saturday, May 13, 2017

Location: Rota-Kiwan Scout Reservation, 6278 Texas Dr, Kalamazoo, MI 49009, 269-375-0027

Prerequisites: NYLT is for young men and women who are registered Boy Scouts, Varsity, Explorers, or Venturers and:

  • Scouts must be 13 years old, and no older than 18, by June 30, 2017.
  • Venturers must be 14 years old, and no older than 21, by June 30, 2017.
  • Scouts must be at least First Class by June 1, 2017.
  • Completion of Introduction to Leadership Skills for Troops or Crews.
  • Currently hold, or will hold, a troop/team/crew leadership position by NYLT.
  • Are mature enough and responsible enough to spend an entire week camping with Scouts that they have never met, with minimal adult supervision, and live by the Scout Oath & Law or the Venturing Code.
  • Agree to practice the skills learned at NYLT upon returning home to theirtroop/team/crew.
  • Parents and Scoutmaster/Advisor must agree and recommend the participant.
  • Must haveavalid BSA “AnnualHealthand Medical” form, including Parts A,B C (doctor’s physical) less than 1 year old (dated after 6/30/2016).

First: Last:

Nickname: Gender: ( ) Male ( ) Female

Mailing Address:

Home Phone Number: ______Date of Birth:

School: ______Grade: ______

Scoutmaster/ Adviser: Unit:

Rank: Leadership Position(s):

District: Council:

T-shirt Size (Adult S-XXXL): AdditionalT-shirts requested: X $15 = $

(Participant receives two (2) shirts as part of the registration fee)

Special dietary, medical or physical considerations the staff should be aware of:

______

______

Participant’sAgreement:

I agree to live by the Scout Oath & Law/Venturing Codeand the Course Code of Conduct while in camp. I understand that if I do not, the Course Director has the discretion & right to send me home at my own expense at any time. I commit to developing a Personal Vision for using my new NYLT skills to benefit my home unit and fellow Scouts after completing the Course.

Signed: Date: E-Mail Address:

Approval ofParent or Guardian:

I give my permission for my Scout to participate in NYLT, and for Course Staff to arrange for emergency medical treatment, if necessary.

Signed: Date: E-Mail Address:

Phone(s): ______

Approval ofUnit Leader:

I believe that this Scout has the maturity and skills to participate in NYTL, and I will work with him/her to develop and implement their Personal Vision in our unit after the course.

Signed: Date: E-Mail Address:

Questions? The Course Director is Julia Bloch: , (269) 979-5601

The course administrative assistant is David Blythe: , (231) 638-2227

Please return this form to Mr. Blythe as soon as possible. A BSA Medical Form (Parts A, B & C) dated after 6/30/16 is also required. Both forms can be mailed to Mr. Blythe at:

4331 Bronson Blvd.

Kalamazoo, MI 49008

This Permission Slip does NOT constitute registration for the Course, but provides contact information and documents parent and unit Leader approval for the participant to attend the Course. Register online at .

Cost: $230 early-bird registration (by 4/1), $250 regular registration. Registration closes 6/1.