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
2 digit month, 2 digit day, 4 digit yearDate
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
2 digit month, 2 digit day, 4 digit yearDate
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
2 digit month, 2 digit day, 4 digit yearDate
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)
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:

Cub Scout Youth Electronic Application

Registration Fee for 12 months *

Registration Fee for 12 months