Online Club Roster Form

Club Number

Church Name(Required)

Church Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Head Counselor Name(Required)

First Last

Head Counselor Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Head Counselor Phone(Required)

Head Counselor Email(Required)

Counselors

Counselor Name	Counselor level	Counselor Address	Counselor Phone	Counselor Email	Counselor Certified?	Counselor Certification Date	Head Counselor Certified?	Head Counselor Certification Date	Junior Counselor Certified?	Junior Counselor Certification Date	Camporee Certified?	Camporee Certification Date	Actions

There are no Counselors.

Church Board Member Signature(Required)

Our church approves the men listed as Cadet counselors in our church's Cadet club.

Church Board Member Signature Date(Required)

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