Cub Scout Pack 169 Austin - Information Form
We use this form to collect additional information that will help us stay connected with you and help your child have a enjoyable Scouting experience.
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New Cub Scout Information
Scout's First Name *
Scout's Last Name *
Scout's Gender *
Scout's Grade (in Fall 2023) *
Scout's Date of Birth *
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Street Address *
Zip Code *
Ethnic Background
School *
Parent/Guardian Information
Parent/Guardian 1 First Name *
Parent/Guardian 1 Last Name *
Relationship to Scout *
Parent/Guardian 1 Phone Number *
Parent/Guardian 1 Email Address *
Parent/Guardian 1 Date of Birth *
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Parent/Guardian 1 Gender *
Parent/Guardian 1 Occupation *
Parent/Guardian 1 Employer *
Parent/Guardian 2 First Name
Parent/Guardian 2 Last Name
Parent/Guardian 2 Phone Number
Parent/Guardian 2 Email Address
Release of Liability/Photo Release
My child, listed above, is a member of Cub Scout Pack 169.  I understand that the Town & Country Optimist Club is the chartering organization for Pack 169. I agree to release the Town & Country Optimist Club from all liability associated with its chartering of Cub Scout Pack 169 and will hold harmless Town & Country Optimist Club liability for any accident, injury, or other damages suffered by my child when he/she is engaged in any scouting activities with Pack 169.

I  hereby grant to Cub Scout Pack 169, its Pack committee and adult leaders (the “Pack”) the right and permission to use and publish the photographs/film/video tapes/electronic representations and/or sound recordings made of my child, and I hereby release the Pack from any and all liability from such use and publication. I understand that these images/photographs/videos can be viewed by anyone in the world. I hereby authorize the reproduction, exhibit, broadcast, electronic storage and/or distribution of said photographs/ film/video tapes/electronic representations and/or sound recordings without limitation at the discretion of the Pack and without compensation.

By entering your full name below, your signature will be deemed applied to this document.
Parent/Guardian (First and Last Name) *
Pursuant to the Texas Uniform Electronic Transmissions Act, an electronic signature has the same legal effect as a manual or handwritten signature. An electronic signature will not be denied legal effect or enforceability solely because it is electronic, and any requirement for a signature is satisfied by an electronic signature. By submitting an electronic signature, the individual identified and providing the electronic signature herein verifies acknowledgement of the binding legal effect and enforceability of the electronic signature. By clicking the box beside "I agree", you agree that this is valid as your signature. You hereby swear that you are the above named student and that the information is accurate to the best of your knowledge. *
Required
Date *
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