Register for Session

CIT I

Conestoga

July 21 - July 30

Learn about leadership, outdoor education, and child devlopment. Must apply. Applications available at local Girl Scout Leadership Center or by emailing ValH@GirlScoutsToday.org.

Camper Information

First Name
MI
Last Name
Address
City
ST
Zip
Birthday (mm/dd/yy) / /
Grade (Fall 2013)
T-Shirt Size

Adult Partner (If applicable, for partner camps only)

Adult Partner
T-Shirt Size

Parent/Guardian

First Name
MI
Last Name
Address
City
ST
Zip
Email
Confirm Email
Phone
Alt Phone
Employer
Employer Phone

Parent/Guardian

First Name
MI
Last Name
Address
City
ST
Zip
Email
Phone
Alt Phone
Employer
Employer Phone

Additional Information

Special Needs
Buddy Name
Only one girl buddy may be listed. Listing more than one buddy will result in a processing delay and campers will not be guaranteed joint placement.

Emergency Contact

Please list at least one adult person (not a guardian/parent listed above).

Name
Relation to Camper
Phone
Alt Phone

Signature

I have read and understand the camp information and agree that my camper and I will abide by the stated regulations and procedures, including camper information form and other requirements, and refund /cancellation policies. I understand that my camper needs to be a currently registered Girl Scout and that there is a $25 non-refundable deposit for each session that my camper attends. I understand that I am responsible for getting my camper to camp and picking her up on time. I give my permission for my camper to attend and participate in all phases of activities (except those noted on the camper health record), including off-site travel when it is part of the program. I understand that when participating in Girl Scout activities, participants may be photographed for print, video or electronic imaging, and that those images may be used in published formats and belong to the Girl Scouts.

Parent/ Guardian Signature
Date