Pack 1232 - Selkirk Volunteer Fire Company No 2 201852143 APPLICATION DETAILS Application ID 201852143 Parent / Guardian MemberID ID 141673306 Applicant Member ID 141673310 Applied to Organization Twin Rivers Council 364, Fort Orange 01, Pack 1232, Selkirk Volunteer Fire Company No 2 Submitted Date 08/10/2025 00:00:00 Current Status Completed Current Status Date 08/10/2025 10:57:57 BSA Youth Registration (Trad.) $85.00 Scout Life Domestic Rates $15.00 Council Fee $57.00 Administrative Fee OLR $2.75 1 STEP 1: YOUTH INFORMATION First Name Evelyn Last Name Spitz Age 6.5y Gender Female Grade First Grade Ethnic Background Caucasian/White Country USA Address Line 1 58 Saint Clair Drive Address Line 2 City Delmar State NY Zip Code 12054 Personal and Confidential for Authorized BSA Use Only Page 1 YOUTH APPLICATION

Pack 1232 - Selkirk Volunteer Fire Company No 2 201852143 2 STEP 2: PARENT INFORMATION First Name Carrie Middle Name Last Name Spitz Age 34y Gender Female Ethnicity Caucasian/White Relationship to youth Daughter of Country USA Address Line 1 58 Saint Clair Drive Address Line 2 Address Line 3 City Delmar State NY Zip 12054 Phone Number 001 (516) 314-6777 Email Address spitz.carrie@gmail.com Personal and Confidential for Authorized BSA Use Only Page 2 YOUTH APPLICATION

Pack 1232 - Selkirk Volunteer Fire Company No 2 201852143 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

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Original PDF: Evelyn Spitz Application.pdf