Boy Scouts of America|
San Diego - Imperial Council
1207 Upas Street
San Diego, CA 92103-5198
High Adventure Team
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: _______________________________________________________________