Additional Adult Information

What is your relation to the youth (Grandparent, Aunt, Uncle, Nanny, ect.)? *

First Name *

Last Name *

Street Address *

City *

Zip Code *

Phone Number *

Email Address *

Parent/ Legal Guardian Information

Click here if address is the same as youth

Select relationship *

Parent

Legal Guardian

First Name (Full Legal Name) *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Date of Birth (MM/DD/YYYY) * +

Occupation

Email Address *

Would you be willing to help out as den leader? *

Yes, sign me up.

Need more information

Preferred way to contact *

Phone

Email

Any

Click here if you are an adult, other than a parent/legal guardian (Grandparent, Aunt, Uncle, Nanny, ect.) signing up a youth for Scouting