Page 1 of 3 Pack 1232 - Selkirk Volunteer Fire Company No 2 201565980 APPLICATION DETAILS Application ID 201565980 Parent / Guardian MemberID ID 134674474 Applicant Member ID 141415963 Applied to Organization Twin Rivers Council 364, Fort Orange 01, Pack 1232, Selkirk Volunteer Fire Company No 2 Submitted Date 12/05/2024 00:00:00 Current Status Completed Current Status Date 12/05/2024 13:50:54 BSA Youth Registration (Trad.) $85.00 Council Fee $40.00 Administrative Fee OLR $3.75 1 STEP 1: YOUTH INFORMATION First Name Mackenzie Last Name Knott Age 8.5y Gender Female Grade Kindergarten / Grade Prior to the First Grade Ethnic Background Caucasian/White Country USA Address Line 1 24 Magee Dr Address Line 2 City Glenmont State NY Zip Code 12077 Personal and Confidential for Authorized BSA Use Only Page 1 YOUTH APPLICATION
Page 2 of 3 Pack 1232 - Selkirk Volunteer Fire Company No 2 201565980 2 STEP 2: PARENT INFORMATION First Name Michael Middle Name Last Name Knott Age 47.5y Gender Male Ethnicity Caucasian/White Relationship to youth Daughter of Country USA Address Line 1 24 Magee Dr Address Line 2 Address Line 3 City Glenmont State NY Zip 12077-3412 Phone Number 001 (518) 275-0960 Email Address dakotaharley@hotmail.com Personal and Confidential for Authorized BSA Use Only Page 2 YOUTH APPLICATION
Page 3 of 3 Pack 1232 - Selkirk Volunteer Fire Company No 2 201565980 2 STEP 3: ADULT PARTNER INFORMATION First Name Middle Name Last Name Age y Gender Ethnicity Relationship to youth Country Address Line 1 Address Line 2 Address Line 3 City State Zip Phone Number Email Address Personal and Confidential for Authorized BSA Use Only Page 3 YOUTH APPLICATION
Original PDF: Mackenzie Knott Application.pdf