Join ⋆ Sea Scout Ship 25

Youth Information

Youth Full Legal Name*

First Name*

Middle Name

Last Name*

Suffix

Preferred Nickname

Youth Applicant Mailing Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Phone

Youth’s Email*

Date of Birth*

day

/

month

/

year

Gender*

Male

Female

School Name

Grade Level (grade entering in August 2021)

Parent/Legal Guardian Information

Same Address*

Address is same as above

Address is different from above

Select relationship:

Parent

Legal Guardian

Grandparent

Other (Specify)

Parent/Legal Guardian Full Legal Name*

Parent/Legal Guardian First Name*

Parent/Legal Guardian Middle Name

Parent/Legal Guardian Last Name*

Parent/Legal Guardian Suffix

Parent/Legal Guardian Address (if different from above)

Parent/Legal Guardian Mailing Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Parent/Legal Guardian Phone

Parent/Legal Guardian Alternate Phone

Parent/Legal Guardian Email*

Parent/Legal Guardian Date of Birth*

day

/

month

/

year

Parent/Legal Guardian Gender*

Male

Female

Parent/Legal Guardian Occupation*

Parent/Legal Guardian Employer*

Previous Parent/Legal Guardian Scouting experience

Signature*

I have read the attached information for parents and approve the application. I affirm that I have or will review How to Protect Your Children From Child Abuse: A Parent's Guide.

Read How to Protect Your Children From Child Abuse: A Parent’s Guide

Today’s Date

Word Verification