VENTURE
CREW
PARENT
PARTICIPATION SURVEY
Crew
Member Name: ____________________________________
Participating
Adults:
Male Female Birth Date
Adult
#1 - ___________________________
[ ] [
] _____/_____/_____
Adult
#2 - ___________________________
[ ] [
] _____/_____/_____
Adult
#3 - ___________________________
[ ] [
] _____/_____/_____
The family members (or family
caregivers), over the age of 25, identified above would like to participate in
the following Venture Crew activities:
[
] Provide transportation to/from campouts attended by
the above Crew Member:
TDL #
[
] Adult #1
TX______________
[
] Adult #2
TX______________
[
] Adult #3
TX______________
[
] The vehicle most likely to be used is (we need this
information in order to
provided it to the BSA Scout Office prior to trip departure):
Make
of vehicle: ______________ # Total Seat belts _____
Model:
__________________
Model year: __________
Liability Coverage: [
] $50,000/$100,000/$50,000
(BSA require minimum)
[
]
$100,000/$300,000/$50,000
[
]
$250,000/$500,000/$250,000
[
]
$
/$
/$
[
] Provide BSA two-deep adult leadership for the
following Crew activities attended by the above Crew Member:
Adult #
#1 #2 #3
[ ] [ ] [ ] -
One or more week-end campouts (1-2 days)
[ ] [ ] [ ] -
One or more long-term campouts (7-10 holidays/summer days)
[ ] [ ] [ ] -
One or more week-end campouts (1-2 days)
[ ] [ ] [ ] -
One or more Crew meetings in Austin (1-3 hours)
[ ] [ ] [ ] -
Organize/assist with periodic/annual Crew activities:
