THE 2017 NATIONAL
SCOUT JAMBOREE
July 19 – 28, 2017
The Summit Bechtel Family
National Scout Reserve, West Virginia
We're talking seriously high adventure, people!
Whitewater rafting, zip-lining, rappelling, mountain
biking, and more - with 30,000 of your closest friends at
the Summit Bechtel Reserve in the wilds of West VA.
Boy Scouts and Venturers can be a member of the Samoset Council Contingent
if you meet the participant qualifications outlined on page 2.
Estimated cost for this experience is $1,850 per Scout.
Space in the Council Contingent will be limited and will be allocated on a first-come, first-served
basis until our allocation is filled. To apply for a space in the contingent, submit this form with your
non-refundable deposit of $200.00 (via check, credit card, or cash).
Participant Name: ___________________________________________________________
I wish to attend as a:
Date of Birth:
□ Boy Scout
□ Venturer
Unit Type:
_ Unit Number:
_
Street Address: _____________________________________________________________
City, State, & ZIP:
__________________________________________________________
Parent/Guardian Cell Phone: ___________________________________________________
Parent/Guardian E-Mail: _______________________________________________________
Submit this form to the Council Service Center with your non-refundable deposit of $200.00 to
reserve a spot. Make checks payable to Samoset BSA.
Questions about the Samoset Council Jamboree Contingent should be addresses to Scott Domino.
Samoset Council
3511 Camp Phillips Rd
Weston, WI 54476
715-355-1450
Scout Participant Qualifications:
 Scouts members MUST have a current BSA membership with a Boy Scout troop.
 Must be at least a First Class Scout before July 2017.
 Must be at least 12 years of age by the first day of the Jamboree or an 11 year old that has
graduated the 6th grade, but has not reached their 18th birthday by the last day of the
Jamboree.
 Be approved by the unit leader and Samoset council.
 MUST have appropriate parent/guardian to complete the online parental consent. (An email
will be sent to the parent/guardian during the application process.)
 Participate in pre-jamboree training experience.
 File a BSA Health & Medical Record within one year of attending the Jamboree. (The Samoset
council will provide specifics closer to the Jamboree.)
 Submit all registration fees per the payment schedule below.
Venturing Participant Qualifications:
 Crew members MUST have a current BSA membership with a Venturing crew.
 Be approved by the unit leader and Samoset council
 MUST have appropriate parent/guardian to complete the online parental consent. (An email
will be sent to the parent/guardian during the application process.)
 Participate in pre-jamboree training experience.
 File a BSA Health & Medical Record within one year of attending the Jamboree. (The Samoset
council will provide specifics closer to the Jamboree.)
 Submit all registration fees per the payment schedule below.
Payment Schedule is as follows:
 $200 Deposit due with registration
 $400 First Payment due 6/1/2016
 $400 Second Payment due 9/1/2016
 $400 Third Payment due 12/1/2016
 $450 Final Payment due 3/1/2017
I understand that I must make all payments on time and according to the payment schedule above. If
payments are not made according to the schedule, I understand that I may be dropped from the active
roster and moved to the wait list until payments are made current.
If you should decide to drop from the Council contingent, a paid replacement must be found before any
refunds can be granted. If you drop out within three months of the Jamboree departure date, no refund
will be granted until after the Jamboree to ensure that we have payment for a full contingent. If we do
not have a full contingent, no refunds will be granted.
I understand that while submission of this form and payment of the required fee will temporarily reserve
a space in the Council contingent, registration is not complete until the BSA on-line registration process
is completed and your application is approved by the Samoset Jamboree committee.
____________________________________________________________
Participant (Youth) Signature
Date
____________________________________________________________
Parent/Guardian Signature
Date