Register for Session

• First Name
• MI
• Last Name
• Address
• City
• ST
• Zip
• Birthday (mm/dd/yy) / /
• Grade (Fall 2013)
• T-Shirt Size Small Medium Large Small Medium Large X Large 2X Large 3X Large

• Adult Partner Male Female
• T-Shirt Size Small Medium Large X Large 2X Large 3X Large

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

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

• 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.

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

• Name
• Relation to Camper
• Phone
• Alt Phone

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