Cub Scout Youth Electronic Application...Timuqua District

Cub Scout Youth Electronic Application
Youth's name?*

First NameMiddle NameLast Name
Youth's address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Youth's date of birth?*

MonthDayYear
Date
Youth's Gender?*
Youth's ethnic background?*
What county is your son or daughter's elementary school located?*
In Brevard County, what is the name of your son or daughter's elementary school?*
In Flagler County, what is the name of your son or daughter's elementary school?*
In Lake County, what is the name of your son or daughter's elementary school?*
In Orange County, what is the name of your son or daughter's elementary school?*
In Osceola County, what is the name of your son or daughter's elementary school?*
In Seminole County, what is the name of your son or daughter's elementary school?*
In Volusia County, what is the name of your son or daughter's elementary school?*
What grade in school is your son or daughter in?*
Guardian Name?*

First NameMiddle NameLast Name
Is the guardian's address the same as the youth's address?*
If guardian address is not the same as the youth's address, please fill out guardian address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guardian gender?*
Guardian's phone number?*

Area CodePhone Number
Guardian's email?*
example@example.com
Guardian date of birth?*

MonthDayYear
Date
Please select your relationship to the youth?*
Guardian occupation?
Guardian employer?
Previous Scouting experience? If so what was your experience?
Would you or your spouse like to help?
What is today's date?*

MonthDayYear
Date
I have read the information for Parents (located below) and approve this application. I affirm I have or will review How to Protect Your Children From Child Abuse: A Parent's Guide (located below). (If on a computer please use your mouse to sign, if on phone / tablet please use your finger to sign)*

Clear
Please Review Information for Parents:
How to Protect Your Children From Child Abuse: A Parent's Guide:

Registration Fee for 12 months *

USDIncludes credit card processing fee

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human*
Should be Empty: