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CAMP COORDINATORS CONTACT INFORMATION

Pittsburgh and Washington Stations
Trooper Katjie RUMBAUGH
412-299-1607

Uniontown, Waynesburg and Belle Vernon Stations
Trooper Robert BROADWATER
724-415-1000

Troop B Camp Cadet Counselor
Trooper Jessica ZANGLA
724-415-1205

July 2018
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Members List:

Camp Coordinator:
Trooper Robert BROADWATER
Co-Coordinator:
Trooper Katjie RUMBAUGH

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Heritage Reservation Boy Scout Camp

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2018 Camp Application
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2018 Camp Cadet

August 12, 2018-August 18, 2018

COMPLETE AND RETURN:

Trooper Robert BROADWATER 1070 Eberly Way, Lemont Furnace, PA 15456

Name: _______________________________________

Address: ____________________________________

____________________________________

City _______________________________ State _______ Zip code ______

Sex: Male ______ Female ______

Birth date: ____________ Age _________ Adult Shirt Size: S M L XL

County of Residence:____________ School District:_________________ Grade Level:______

Parent/Guardian: _____________________________

Home Phone:_______________ Work Phone:_________________

Parent's E-Mail:________________________________

Has the applicant ever attended a Summer youth camp? _____________

I certify that my physical condition will not restrict me in any educational or sports activities.

______________________________
Applicant Signature/Date

_____________________________
Parent/Guardian Signature/Date

some text

**2018 APPLICATIONS ARE CLOSED**

 
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