Boy Scouts of America San Diego - Imperial Council 1207 Upas Street San Diego, CA 92103-5198 High Adventure Team Phone: (619)298-6121

HIGH ADVENTURE AWARD FORM (print out and mail in)

INSTRUCTIONS: print out a copy of this form, fill in all blanks, then submit to Council Service Center. This application must be complete to obtain awards. Electronic submission is not available as signatures are required. Please type or print.

Unit type: __________   Name of Award: ______________________________________

Unit No.: ___________   Number of Awards requested: _________________________

District: ___________   For ____ Youth and ____ Adults (list names on reverse)

                        BSA Tour Plan number: _______________________________

                        Park/Wilderness/USFS Permit number: _________________

                        Issuing agency: _____________________________________

We, the undersigned in charge, do certify that we have read and understand the complete requirements for the award listed above and we do further certify that all of the participants, whose names are listed on the reverse side, have met all the requirements for the award listed above. We also certify that the High Adventure trained adult listed below participated in the award activity.

Trained Adult: ________________________ Signature: ___________________________

Address: ______________________________ City: _________________ Zip: _________

Phone: ____________________

Water Trek Leader / Backpack Leader Training card number: ________
(Note: Water Trek Leader Training card number required for water activities
       Backpack Leader Training card number required for all other activities)

First Aid Card (type): _______________________________ Date Issued: __________
(First Aid card is desired for all awards, mandatory if required for award)

Signature of Youth in charge: __________________________ Phone: ______________

Address: ______________________________ City: _________________ Zip: _________

The following information is needed for those who will follow in your footsteps and help to improve other opportunities, campsites and trails:

Name of trail: _______________________________________________________________

Locality of trail: ___________________________________________________________

Started trail at (place): __________________________________ Date: ___________

Ended trail at (place): ____________________________________ Date: ___________

Mileage on trail: _________ Campsites used (name or location): _______________

______________________________________________________________________________

Recommendations: _____________________________________________________________

Conservation / Trail Building (hours per person): ____________________________

Where: _______________________________________________________________________

What was done: _______________________________________________________________