| Scout Personal Data Collection Form Name: ________________________________________ Nickname: ____________________ BSA ID#: ____________________ Address: ______________________________ Mailing: ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Phone(s) Home: (___) __________ DOB: __/__/__ _____________: (___) __________ Grade: _____ _____________: (___) __________ School: ______________________________ Email: ______________________________ Joined Unit: __/__/__ Became Tiger: __/__/__ Became Cub: __/__/__ Boys Life: Y / N Eligible Webelos: __/__/__ Became Webelos: __/__/__ Health form on file: Y / N Emergency Contact: _________________ Phone: (___) __________ Class 1 Phys: __/__/__ Doctor: _________________ Phone: (___) __________ Class 2 Phys: __/__/__ Insurance: _________________ Policy: ____________ Class 3 Phys: __/__/__ Allergies: ____________________________________________________________ Other: ____________________________________________________________ Father: ______________________________ Mother: ______________________________ Guardian: Y / N Guardian: Y / N Phone(s) Work: _______________ Phone(s) Work: _______________ ____________: _______________ ____________: _______________ ____________: _______________ ____________: _______________ Email: _________________________ Email: ______________________________ Drivers Lic: _______________ ST: ___ Drivers Lic: _______________ ST: ___ Employer: ______________________________ Employer: ______________________________ Occupation: ______________________________ Occupation: ______________________________ Insurance (in thousands) Vehicle(s) (Year/Make/Model) # Belts Lic Plate Per Person Per Accident Property ____________________ ____ __________ __________ __________ __________ ____________________ ____ __________ __________ __________ __________ Remarks: ____________________________________________________________ |