GNYC CAMPERSHIP FORM FOR SUMMER CAMP

Parents In order for your son(s) campership application to be accepted by Greater New York Councils you are required to fill-out all camper Information, Parent Information, and Family Income. Unit Leaders are required to collect applications and a (non-refundable) deposit of $25 per camper, per week/session for each application submitted. This eliminates incomplete applications, payment confusion and delays.

Send Completed Form To: Boy Scouts of America, Greater New York Councils (GNYC), 350 Fifth Avenue, Suite 7820, New York, NY 10118 or Fax: (212) 651-2445. The GNYC only administers Camperships to GNYC registered youth who participate at GNYC Camps. Checks are made payable to GNYC, BSA

Note: Each Scout requesting campership money are required to fill pick-up postcards from your District Roundtable and submit with campership application to your Cub or Scout Master. 1 postcard is required for every $25 requested. Scouts must write a thank you note completed with campers name, council and pack #.

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PRINT LEADER NAME: ______________________________________________ Contact # __________________________ Email: _____________________________

UNIT TYPE:  Cub Pack  Scout Troop  Venture Crew  Ship UNIT #: ___________ CAMP UNIT (if different from Home Unit) #: ____________ BOROUGH: Bronx Brooklyn Manhattan Queens Staten Island
DISTRICT: Bronx River Lenape Bay Brukelen Big Apple Founders Pathfinder Tomahawk Aquehonga

CAMP DATES AND FEES: All prices below are effective until May 31st. After May 31st late fee charge will apply: $15 per session and $30 per week.

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CUB WORLD

Cub World – $200. per session Cub World – $360. per week

TEN MILE RIVER

Ten Mile River – $365. per week
Ten Mile River Provisional Troop – $365. per week

SPECIALTY CAMPS

Ten Mile River Trek – $380. per week
Ten Mile River Specialty Camp – $380. per week

 TMR Provisional Troop (Keowa WKs – 1,2,3,4,5)  National Youth Leader Training (Keowa Wk 1) Film & TV Production Camp (Keowa WK 2) Eagle Camp (Keowa Week 3)

Aviation Camp (Keowa Wk 4)
Eagle Camp (Ranachqua Week 5) Shooting Sports Camp (Keowa Week 5) Aquatics Camp (Keowa Week 6)
Eagle Camp (Aquehonga Week 6) TMR Provisional Troop (Aquehonga Wk 6)

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 Session 1A:
 Session 1B:
Session 2A:
Session 2B:
Session 3A:
 Session 3B:
Session 4A:
Session 4B: Session5A-July27-30 Session 5B – July 30 – Aug. 2

 Week 0 June 29 – July 5  Week 1 July 6 – 12
 Week 2 July 13 – 19
 Week 3 July 20 – 26
 Week 4 July 27 – August 2  Week 5 August 3 – 9

 Week 6 August 10 -16

June29-July2 July2-5
July 6 – 9
July 9 – 12

 Aquehonga Keowa
 Ranachqua

July 13 – 16 July16-19 July 20 – 23 July 23 – 26

CAMPER INFORMATION (Print Clearly):

First Name: ________________________________________ Last Name: _____________________________________________ Date of Birth: ______________________ Address:________________________________________________ Apt. #________ City:_____________________________________ State:_______ Zip: _____________ School Attending: ________________________________________________________________________ Scout Rank _______________________ Grade: ____________

PARENT/GUARDIAN INFORMATION (Print Clearly):

First Name: __________________________________________________ Last Name:____________________________________________________________________ Address:__________________________________________________ Apt. #__________ City:_____________________________ State: ________ Zip: _______________ Contact #: ________________________________________________________ Contact #: ________________________________________________________________ Email: ____________________________________________________________________________________________

Alternate Contact First Name: __________________________________________________ Last Name: ______________________________________________________ Contact #: ______________________________________________________________ Email: ______________________________________________________________

FAMILY INCOME: Total yearly income must reflect all types of income: salary, unemployment, pensions, alimony, etc. GNYC Amount Approved for all family members. Financial hardship must be specified. Your application will be denied if hardship is not explained. for Office Use Only

Total Yearly Income for house hold (Gross): $ __________________ *Campership Amount Requested $_____________

Number of Family Members Residing at Home: __________ Adults __________ Children # of children attending Scout camp ____________.
Briefly Explain Hardship: ______________________________________________________________________________________________________________________

________________________________________________________________________________________________________ ________________________________________________________________________________________________________

*Each Scout requesting campership money will need to Pick-up postcards from your District Roundtable or the Council Office and submit with campership application. 1 postcard for every $25 requested.

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Rev. 10/2013

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GREATER NEW YORK COUNCILS BOY SCOUTS OF AMERICA

Dear Parent/Scout Leader:

2014 CAMPERSHIP APPLICATION

►It is imperative to fully complete this form. Any information missing will not be assumed. Missing information will cause the form to be rejected without consideration until filled completely.

►Total yearly income must reflect all house hold family members. We ask you to include the following types of house hold income: salary, unemployment, pensions, alimony, disability, public assistance, etc.

►When expressing financial hardship please furnish explicit details.

►$25 Deposit must be paid per camper, per week for application to be considered. A campership request will be rejected unless the deposit is paid. The campership amount you are requesting must be specified.

►In order to accurately credit the unit with the campers awarded amount, the Council, District, Pack/Troop information must be completed. Campers crossing over must indicate new unit # and unit attending camp with. Please make sure camper’s transfer information is submitted to GNYC office on time to avoid confusion in locating camper with the appropriate unit.

►All campership amounts awarded will be based on the Early Bird cost. No consideration will be given for the higher fee charged after May 31st.

►Follow-up inquiries need to be given to your District Executive by May 28th to receive awarded campership amount before May 31st. All applications not received by May 28th will have to make a full payment-less the requested amount-to receive Early Bird discount. Reimbursement, if any will be provided in a Pack/Troop check while unit is at camp . We do not make checks out to individuals.

See reverse side for additional required information

Note: In order for your campership application to be considered you must provide a receipt number or enclose a $25 deposit per week with this application.

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Have you paid $25 DEPOSIT per week?  YES  NO  Is it an individual payment?
 Is it included with unit payment?

PAYMENT TYPE

 Cash  Check # _____________________
 Discover  Visa  Master Card  American Express

Required Receipt # _______________________

 Credit Card # ______________________________________ Expiration Date: ____________________________________

Print Name: __________________________________ Signature:_________________________________________________

CHECK WHICH APPLY (optional):

Our Unit participated in the following Council activities from June 1, 2013 – May 31, 2014:  District Bowl-A-Thon  Hike-A-thon  Product Sales

Our Unit scheduled and held the following presentation:  Friends of Scouting  Camp Presentation

CUSTOMER SERVICE: If you have any questions, please call Camping Services at (212) 651-3073 or Email Camping Services at: Camp- ing@bsa-gnyc.org. Forms can be downloaded at www.alpinescout camp.org or www.tenmileriver.org.

Thank you for Camping at Greater New York Councils Camps. Providing you with an extraordinary outdoor adventure is our goal!

Date submitted to GNYC Office with payment:

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