SFV Scouts Register

Fill out the form below and let our leaders know if you have any questions. Can't wait to see everyone there!

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Parent 1

Title

First Name

Last Name

Street Address

Street Address Line 2

City

State/Province

Postal Code

Phone Number

All Emails on this form MUST BE UNIQUE.

Affiliate Category

Affiliate Year

Affiliate Subcategory

Parent 2

Title

First Name

Last Name

Phone Number

All Emails on this form MUST BE UNIQUE.

Emergency Contact

First Name

Last Name

Phone Number

All Emails on this form MUST BE UNIQUE.

Relation to Child(ren)

How many children are you enrolling?

Child 1

First Name

Last Name

Birth Date

Enter year/month/day

Gender

Age

Please fill out the following applicant information if your child is 13 years or older.

Phone Number

All Emails on this form MUST BE UNIQUE.

School Name

Grade

Health Information

Primary Physician Name

Phone Number

Date of Last Physical Exam

Health Insurance Carrier

Policy Number

Allergies

Activity Restrictions

Dietary Restrictions

Current Medication(s)

Reason(s) for medication(s)

Alumni Category

Alumni Year

Alumni Subcategory

Child 2

First Name

Last Name

Birth Date

Enter year/month/day

Gender

Age

Please fill out the following applicant information if your child is 13 years or older.

Phone Number

All Emails on this form MUST BE UNIQUE.

School Name

Grade

Health Information

Primary Physician Name

Phone Number

Date of Last Physical Exam

Health Insurance Carrier

Policy Number

Allergies

Activity Restrictions

Dietary Restrictions

Current Medication(s)

Reason(s) for medication(s)

Child 3

First Name

Last Name

Birth Date

Enter year/month/day

Gender

Age

Please fill out the following applicant information if your child is 13 years or older.

Phone Number

All Emails on this form MUST BE UNIQUE.

School Name

Grade

Health Information

Primary Physician Name

Phone Number

Date of Last Physical Exam

Health Insurance Carrier

Policy Number

Allergies

Activity Restrictions

Dietary Restrictions

Current Medication(s)

Reason(s) for medication(s)

Child 4

First Name

Last Name

Birth Date

Enter year/month/day

Gender

Age

Please fill out the following applicant information if your child is 13 years or older.

Phone Number

All Emails on this form MUST BE UNIQUE.

School Name

Grade

Health Information

Primary Physician Name

Phone Number

Date of Last Physical Exam

Health Insurance Carrier

Policy Number

Allergies

Activity Restrictions

Dietary Restrictions

Current Medication(s)

Reason(s) for medication(s)

Child 5

First Name

Last Name

Birth Date

Enter year/month/day

Gender

Age

Please fill out the following applicant information if your child is 13 years or older.

Phone Number

All Emails on this form MUST BE UNIQUE.

School Name

Grade

Health Information

Primary Physician Name

Phone Number

Date of Last Physical Exam

Health Insurance Carrier

Policy Number

Allergies

Activity Restrictions

Dietary Restrictions

Current Medication(s)

Reason(s) for medication(s)

Additional Information

How did you hear about AGBU-AYA San Fernando Scouts?

Returning Family

Website

Community

Google

Word-of-Mouth (friend)

I am over 18 years old

Additional Notes

Code (For internal use only)

By checking this, I acknowledge reading and agreeing to the terms of:

- Liability and Health Screening Waiver
- Scouting Waiver

Total $ 300.00

Please read our Cancellation/Refund Policy.

AGBU respects your privacy. The data included above is maintained in compliance with international privacy standards (including GDPR) and used to communicate with you about our events, programs and news. To manage your AGBU subscription, email dbupdate@agbu.org. For more information, please read our Privacy Notice and Terms and Conditions.

San Fernando Valley Scouts Registration

Parent 1

Parent 2

Emergency Contact

Child 1

Please fill out the following applicant information if your child is 13 years or older.

Health Information

Child 2

Please fill out the following applicant information if your child is 13 years or older.

Health Information

Child 3

Please fill out the following applicant information if your child is 13 years or older.

Health Information

Child 4

Please fill out the following applicant information if your child is 13 years or older.

Health Information

Child 5

Please fill out the following applicant information if your child is 13 years or older.

Health Information

Additional Information

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