Fillable U S A YOUTH INFORMATION Male Female BSA

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U S A YOUTH INFORMATION Male Female BSA

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BSA YOUTH MEMBER APPLICATION
YOUTH INFORMATION
First name (Full legal name) Middle name Last name Sufx Preferred nickname
Country Mailing address City State Zip code
U S A
Phone Date of birth (mm/dd/yyyy) Grade Ethnic background: Gender:
- - / /
Black/African American Native American Alaska Native
Male Female
School
Caucasian/White Pacic Islander Asian
Hispanic/Latino Other
Scout Life subscription
PARENT/LEGAL GUARDIAN INFORMATION
Mark here if address is same as above. Mark here if you are the Lion or Tiger adult partner. Mark here if the Lion or Tiger adult partner is not living at the same address and complete and attach an adult application.
Select relationship:
Parent Legal Guardian Grandparent Other (specify)
First name (Full legal name) Middle name Last name Sufx Preferred nickname
Country Mailing address City State Zip code
U S A
Primary phone Date of birth (mm/dd/yyyy) Occupation Employer Gender:
- - / /
Male Female
Alternate phone Ext. Previous Scouting experience
- -
x
I have read the attached information for parents and approve the
application. I afrm that I have or will review How to Protect Your
Children From Child Abuse: A Parent’s Guide. Parent/legal guardian email address
/ /
Signature of parent/legal guardian Date
To be completed by unit
/ /
Signature of unit leader (or designee) Date
Unit type:
Pack Troop Crew Ship Lone Cub Scout Has earned
Arrow of Light
Lone Scout
Unit No.:
For pack registration select one:
Lion Tiger Wolf Bear Webelos
If applicant has unexpired membership certicate, registration may be accomplished at
no charge by transferring the registration or multiple registering.
Transfer application
Multiple application
Enter membership number
from unexpired certicate:
Council No.:
Unit
type:
Pack Troop
Unit No. or district name:
Crew Ship
Registration fee
$
Scout Life fee $
524-406
PAID: ○ Cash ○ Check No. _______ ○ Credit card
TURN ON "CAPS LOCK" WHEN FILLING OUT FORM
CLEAR FORM
SAVE FORM
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COUNCIL COPY
BSA YOUTH MEMBER APPLICATION
YOUTH INFORMATION
First name (Full legal name) Middle name Last name Sufx Preferred nickname
Country Mailing address City State Zip code
U S A
Phone Date of birth (mm/dd/yyyy) Grade Ethnic background: Gender:
- - / /
Black/African American Native American Alaska Native
Male Female
School
Caucasian/White Pacic Islander Asian
Hispanic/Latino Other
Scout Life subscription
PARENT/LEGAL GUARDIAN INFORMATION
Mark here if address is same as above. Mark here if you are the Lion or Tiger adult partner. Mark here if the Lion or Tiger adult partner is not living at the same address and complete and attach an adult application.
Select relationship:
Parent Legal Guardian Grandparent Other (specify)
First name (Full legal name) Middle name Last name Sufx Preferred nickname
Country Mailing address City State Zip code
U S A
Primary phone Date of birth (mm/dd/yyyy) Occupation Employer Gender:
- - / /
Male Female
Alternate phone Ext. Previous Scouting experience
- -
x
I have read the attached information for parents and approve the
application. I afrm that I have or will review How to Protect Your
Children From Child Abuse: A Parent’s Guide. Parent/legal guardian email address
/ /
Signature of parent/legal guardian Date
To be completed by unit
/ /
Signature of unit leader (or designee) Date
Unit type:
Pack Troop Crew Ship Lone Cub Scout Has earned
Arrow of Light
Lone Scout
Unit No.:
For pack registration select one:
Lion Tiger Wolf Bear Webelos
If applicant has unexpired membership certicate, registration may be accomplished at
no charge by transferring the registration or multiple registering.
Transfer application
Multiple application
Enter membership number
from unexpired certicate:
Council No.:
Unit
type:
Pack Troop
Unit No. or district name:
Crew Ship
Registration fee
$
Scout Life fee $
524-406
PAID: ○ Cash ○ Check No. _______ ○ Credit card
UNIT / APPLICANT COPY
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U S A YOUTH INFORMATION Male Female BSA

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Completed 3 February 2022

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