Unit Name: 
Number and Town Name

Your group is from: 

Charter Oak District Leaders of the Revolution District Western District Southeastern District Another Scouting Council Not a Scouting unit

Requested Arrival Date: 

Requested Departure Date: 

Expected number of youth campers: 

Expected number of adult campers: 

Camp Area(s) Requested: 

Turner Cabin - including Pavilion Cub Area Well Two Lynn Shelter Missell Shelter East Region South Region Entire Camp
Indicate multiple areas if necessary

Your Name: 

Address: 

Town/State/Zip: 

Phone: 

Email: 
Confirmation form will be sent via email if an address is supplied

Other Information 

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