Mt. Jefferson Campsite

Reservation Form

District*AbnakiArrowheadHistoricMassabesicMt MonadnockNutfieldSunapeeWannalancitDistrict Committee or GroupCouncil Committee or GroupOutside Group or Organization

Outside Group or Organization Name*

Unit Type*PackCrewTroopPostDistrict or Council GroupOutside Group or Organization

Unit No.*

First name*

Last name*

Email*

Phone*

Address line 1*

City*

State / province*

Zip code*

Unit On-Site Contact*

Unit On-Site Contact E-Mail*

Unit On-Site Contact Phone*

No. Adults (Male)*

No. of Adults (Female)*

No. of Youth (Male)*

No. of Youth (Female)*

Estimated Arrival Time*5:00 AM6:00 AM7:00 AM8:00 AM9:00 AM10:00 AM11:00 AM12:00 Noon1:00 PM2:00 PM3:00 PM4:00 PM5:00 PM6:00 PM7:00 PM8:00 PM9:00 PM11:00 PM

Estimated Departure Time*6:00 AM7:00 AM8:00 AM9:00 AM10:00 AM11:00 AM12:00 Noon1:00 PM2:00 PM3:00 PM4:00 PM5:00 PM6:00 PM7:00 PM8:00 PM9:00 PM10:00 PM

Have Adult Leaders Completed Youth Protection Training*YesNo