EmailMeForm
2020 - 2021 Troop 76 Registration
Please complete this registration form as soon as possible. Adults are required to volunteer to help support the troop. An important part of scouting is Youth Protection. At least one adult family member must complete Youth Protection training to participate in any scouting activity. http://www.scouting.org/Training/YouthProtection.aspx. Date of completion is a required field on this form. Parents must also fill out a Consent to Administer Over the Counter Medications for each scout prior to participating in any Troop outings.
Please complete the required health form parts A & B. https://filestore.scouting.org/filestore/HealthSafety/pdf/680-001_ABC.pdf. This part of the health form DOES NOT require a doctor's visit or signature even though there is a place for one. Parents are requested to complete this form for each of their participating scouts and either mail it to Angie Breitenbach (130 Flat Rock Dr) or email a completed copy to Angie ( abreitenbach@mac.com ). These forms are required by Council for all scouts and are kept safely away in a binder that stays with the Scoutmaster. If you have any questions or concerns about this requirement, please contact Troop Committee Chair Tiffany Carlson .
To ensure all families have a way to support their son's Scouting experience, parents have a choice to participate in planning at least 1 trip or be the planning support for 1 month of meetings and activities. For the trips, parents are needed to help the ASM in charge of the trip to plan and coordinate details. For Troop meetings and activities, parents attend the PLC planning meeting for a given month and every Tuesday meeting during that month. Please refer to the Troop Calendar at: https://troop76.org/Calendars/2020-2021%20-%20Troop76%20Initial%20Calendar.pdf
Troop Membership fees are $200/Scout, $150 for 2nd Scout, $100 for 3rd Scout and due by October 31, 2020. Please make the check payable to Troop 76 and write your child's name and "dues" in the memo line. The check can be given to the John Mooney, Troop Treasurer, at a meeting or mailed to his home: 43B Catoonah Street, Ridgefield, CT 06877. Please contact Tiffany Carlson at troop76committee@gmail.com if financial assistance is needed.
After you have completed this form you will be directed to fill out a Consent to Administer Over the Counter Medications. Please fill Consent to Administer forms out for each Scout in your family.
Scout Name
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First
Last
Scout Email
Scout Cell Phone
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Cell Phone Provider
Scout #2 Name
First
Last
Scout #2 Email
Scout #2 Cell Phone
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Cell Phone Provider
Scout #3 Name
First
Last
Scout #3 Email
Scout #3 Cell Phone
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Cell Phone Provider
Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Prefered Phone
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If cell phone please note provider
Parent /Guardian # 1
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First
Last
Parent /Guardian # 1 Email
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Parent /Guardian # 1 Cell phone
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Cell Phone Provider
Completion Date for BSA Youth Protection
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Parent /Guardian #2 Name
First
Last
Parent /Guardian # 2 Email
Parent /Guardian # 2 Cell phone
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Cell Phone Provider
Completion Date for BSA Youth Protection
Submitted BSA Health Form Part A and B
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Yes
No
Directory opt in/out - Troop 76 will distribute an electronic directory for scouting families in Troop 76. Included in the shared information will be your home address, phone #s and email addresses. This directory is only to be used for scouting purposes related to Troop 76. Please do not share outside the troop or use for any other purposes.
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Yes - include my information in directory
No - please leave my information out
Photo opt in/out - Troop 76 will take pictures during scouting events and share on Troop 76 website, FB page or even local newspaper.
I grant permission to use photographs and/or video of my child on Troop 76's website, Facebook, Instagram, news releases, online, and in other communications related to Troop 76.
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Yes - I grant permission to use my child's photo
No - please do not use my child's photo
Scouting Trips/Meetings - Please choose 3
1st choice
2nd choice
3rd choice
October Parent Helper
November Parent Helper
December Parent Helper
January Parent Helper
February Parent Helper
March Parent Helper
April Parent Helper
May Parent Helper
June Parent Helper
Thanksgiving Campout, (Webelos)
Movie night–Ward Pound Ridge Camping - DEC
Klondike Derby and Camping - JAN
Ski Trip - FEB
Winter Sequassen - JAN/FEB
Heritage Trip - MAR
Igloo Camping - MAR
Sturges Camporee - MAY
Big Trip - JUNE
Camp Sequassen - JULY