Pack 1232 - Selkirk Volunteer Fire Company No 2 201892091 APPLICATION DETAILS Application ID 201892091 Parent / Guardian MemberID ID 141728768 Applicant Member ID 141728767 Applied to Organization Twin Rivers Council 364, Fort Orange 01, Pack 1232, Selkirk Volunteer Fire Company No 2 Submitted Date 08/26/2025 19:18:58 Current Status Completed Current Status Date 09/02/2025 13:26:02 1 STEP 1: YOUTH INFORMATION First Name Jayla Last Name Dolan Age 7.5y Gender Female Grade Second Grade Ethnic Background Caucasian/White Country USA Address Line 1 55 Lamb Ave Address Line 2 City Saugerties State NY Zip Code 12477 Personal and Confidential for Authorized BSA Use Only Page 1 YOUTH APPLICATION

Pack 1232 - Selkirk Volunteer Fire Company No 2 201892091 2 STEP 2: PARENT INFORMATION First Name Justina Middle Name Ann Last Name Justus Age 31.5y Gender Female Ethnicity Not Provided Relationship to youth Daughter of Country USA Address Line 1 55 Lamb Ave Address Line 2 Address Line 3 City Saugerties State NY Zip 12477-2249 Phone Number 001 (845) 430-1947 Email Address JJJays23@yahoo.com Personal and Confidential for Authorized BSA Use Only Page 2 YOUTH APPLICATION

Pack 1232 - Selkirk Volunteer Fire Company No 2 201892091 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: Jala Dolan Application.pdf