Page 1 of 3 Pack 1232 - Selkirk Volunteer Fire Company No 2 201587036 APPLICATION DETAILS Application ID 201587036 Parent / Guardian MemberID ID 141325421 Applicant Member ID 141455922 Applied to Organization Twin Rivers Council 364, Fort Orange 01, Pack 1232, Selkirk Volunteer Fire Company No 2 Submitted Date 12/30/2024 00:00:00 Current Status Completed Current Status Date 12/30/2024 12:26:26 BSA Youth Registration (Trad.) $85.00 Scout Life Domestic Rates $15.00 Council Fee $40.00 Administrative Fee OLR $4.20 1 STEP 1: YOUTH INFORMATION First Name Liam Last Name Clemente Age 5y Gender Male Grade Kindergarten / Grade Prior to the First Grade Ethnic Background Caucasian/White Country USA Address Line 1 122 Thornberry Lane Address Line 2 122 Thornberry Lane City Rensselaer State NY Zip Code 12144 Personal and Confidential for Authorized BSA Use Only Page 1 YOUTH APPLICATION
Page 2 of 3 Pack 1232 - Selkirk Volunteer Fire Company No 2 201587036 2 STEP 2: PARENT INFORMATION First Name Chris Middle Name Last Name Clemente Age 39y Gender Male Ethnicity Caucasian/White Relationship to youth Son of Country USA Address Line 1 122 Thornberry Lane Address Line 2 122 Thornberry Lane Address Line 3 City Rensselaer State NY Zip 12144 Phone Number 001 (516) 424-2020 Email Address chrisclem987@gmail.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 201587036 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: Pack 232 Liam Clemente Application.pdf