June 13th Registration Form

Our June 13^th Med Tac Program was very well attended by scout leaders and scouts. Almost 60 participants will receive Stop the Bleed Certificates through the American College of Surgeons sponsored program. Click Here to confirm your participation if you had not pre-registered. Click Here to download our article in Campus Safety Magazine.

If you did not pre-register and attended the training,
please confirm you attendance below.

Attended June 13th Med Tac Course

If you are human, leave this field blank.

NAME:

Email Address:

Mobile Phone Number:

Are you a Scout or Scout Troop Leader or Parent:

No Yes

Troop or Pack:

Designate Scout or Scout Leader

Rank: *

Are you a Boy Scouts of America Orange County Council Staff or Volunteer:

No Yes

Role:

Department and Location:

Are you a School Leader, School Nurse, or Representative:

No Yes

School:

Role:

Are you a Professional First Responder or Caregiver:

No Yes

Lifeguard:

Security Detail:

Professional Healthcare Worker including EMT:

Other:

If a Worship Center Security, Volunteer, Staff, or Health Team Member:

No Yes

Organization: *

Role: *

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If you did not pre-register and attended the training, please confirm you attendance below.

If you did not pre-register and attended the training,
please confirm you attendance below.