Cub Scout Youth Electronic Application...Timuqua District

Cub Scout Youth Electronic Application
Youth's name? *

First Name Middle Name Last Name
Youth's address? *

Street Address

Street Address Line 2

City State / Province

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

Month Day Year
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 Name Middle Name Last 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

City State / Province

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

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

Month Day Year
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? *

Month Day Year
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 *

USD Description

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 *
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