Cub Scout Religious Emblem Application Submission & Payment

- Application Submission & Payment for Light of Christ & Parvuli Dei Religious Emblems
  
  Congratulations on completing your religious emblem! Please proceed through the steps below to complete the process of earning your Emblem and to receive the Awards Packet at the Religious Emblems Mass (Religious Emblem/Medal, plus the Religious Knot, Parent Pin and Pocket Certificate).
  Step One - Upload Completed Emblem Application with Signatures (Page from Activity Booklet)
  Step Two - Online Application and Payment ($40)
  Applications are due by November 1, 2025 for Scouts who would like to be recognized at the January 2026 Religious Emblems Mass.
  
  Questions? Contact Josephine Golcher at [email protected].
  
  STEP ONE - Upload Completed Emblem Application
  Please CLICK HERE to upload a copy (PDF or JPG/PNG Image) of the Emblem Application found at the back of the relevant Religious Emblem Activity Booklet. All approvals and signatures should show as being obtained. If you have any difficulty uploading, the copies can be e-mailed to Josephine Golcher at [email protected] or mailed to 17794 Winterberry St., Fountain Valley, CA 92708.
  An online application is not considered complete until a copy of the completed Emblem Application is submitted and approved. After uploading the form, return to this page to proceed to Step Two.
  
  STEP TWO - Online Application and Payment
  Scouts who have completed the Light of Christ or Parvuli Dei Emblem Program with his/her parents or guardians should submit the form below to the Diocese of Orange Catholic Committee on Scouting (DCCS) for approval and to complete the process of earning the Emblem. This form may be submitted by the Scout (Parent/Guardian) or the Unit Religious Emblems Coordinator (Multiple submissions for the same emblem can be processed for your unit at one time.).
  
  Payment Options - Payment can be made online via Credit Card or ACH Debit or a Mailed Check (Choose "Pay Later" below). (NOTE: If mailing a check, applications are not considered complete until payment is received.)
  
  Checks can be mailed to:
  DCCS
  Attn: Mike Bergler
  185 Woodbury
  Irvine, CA 92620
  
  Fee is $40 per application for the award packet.
  Please make checks payable to "DCCS." Note Scout/Unit on check memo line.
  
  Questions?
  For questions about payment, contact Mike at [email protected].
  For questions about the applications, contact Josephine Golcher at [email protected].
- Application/Payment Form
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  NOTE: Multiple submissions for the same emblem can be processed at one time.
  
  Religious Emblem Completed REQUIRED Please fill out this field.
  
  How many Scouts are you submitting for? REQUIRED Please fill out this field.
  
  Scout 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Scout 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Scout 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Scout 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Scout 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Scout 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Scout 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Scout 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Scout 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Scout 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phonetic Spelling of Scout’s Name: (To assist readers at the Religious Emblems Mass; Ex.: Raul Gonzalez: rah-OOL gon-SAH-les) REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Scout Phone # Maximum 20 characters Please enter a phone number.
  
  Scout Email Please enter an email address.
  
  Parent/Guardian Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Unit Type REQUIRED Please fill out this field.
  
  Unit # REQUIRED Please fill out this field. Please enter valid data.
  
  Parish/City Attends REQUIRED Please fill out this field. Please enter valid data.
  
  Religious Emblem Award Packet40.0
  
  Phone Number of Person Submitting Form REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email of Person Submitting Form REQUIRED Please fill out this field. Please enter an email address.
  
  Comments
  
  By checking the box below and submitting this form, I hereby apply for the above-stated Religious Emblem(s) and agree to the payment total listed. On my honor as a Scout and a Catholic, I hereby certify that I have faithfully fulfilled all the requirements for this emblem to the best of my ability. I further certify that I have obtained required approvals.
  
  I Agree Please select this field.
  
  Processing Fee REQUIRED Yes I will cover the 3% fee to support the DCCS No, not at this time Please fill out this field.
  
  Total:
  
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