Fillable Day Camp Camper Registration Form printable pdf download

Day Camp Camper Registration

form #870 • 01/16 • page 1 of 1

A fully completed, signed registration packet must be accompanied by these 3 things: 1) Completed

“Day Camp Health History & OTC Medications”, 2) camp payment, and 3) PA/CIT Application (If

applicable). Send all to the address listed on your day camp information page. A completed regista-

tion packet does not guarantee camper placement. Contact the day camp registrar with questions.

DO NOT mail registrations to the Girl Scout service centers.

Day Camp _____________________________________ Camper Name _________________________________________________

Mailing Address __________________________________________City __________________________ State _____ ZIP _________

Guardian ___________________________________________ Buddy Name

__________________________________

(if applicable)

Age ______ DOB ____________ Grade Next Fall _______ School Next Fall _______________________________________________

Check how camper will be participating:

All girls attending day camp must be registered Girl Scouts for the current

membership year. If you will be paying for this membership by credit/debit card



Daisy (K-1)

Brownie (2-3)

Junior (4-5)

Cad (6)

or would like to apply for financial assistance the easiest way to register for



membership is online at girlscoutsosw.org!

Child of Camp Staff

Program Aide-In-Training

Program Aide

Membership

Parent/Guardian #1 (that lives with camper/same address)



My camper is a registered Girl Scout for the current membership year or I will

Name ______________________________ Cell # ( ____ )___________



Please register my camper as a Girl Scout. I will pay Girl Scout day camp fee +

Home # ( ______) ______________ Work # ( _____ ) _____________

$15.00 membership dues. This will register her as a Girl Scout through Sep-

tember 30 of this year.

Email _____________________________________________________

Acceptance and participation in summer programs is the same for everyone without

Parent/Guardian #2

regard to race, color or national origin. As an equal opportunity organization, Girl

Scouts is dedicated to diversity and fully supports the right of equal access for girl and

Name ______________________________ Cell # ( ____ )___________

adult members with disabilities. Girl Scouts of Oregon and Southwest Washington

makes every reasonable effort to ensure this access.

Home # ( ______) ______________ Work # ( _____ ) _____________

We encourage you to voluntarily provide the following information on racial back-

Email _____________________________________________________

ground and ethnicity. This information will be used by Girl Scouts of the USA for

Emergency Contact (other than Parent/Guardian #1 or #2)

statistical purposes only and to help improve outreach efforts and advance the Girl

Scout Movement.

Name _______________________________ Relation ______________

The registrant’s racial background is (please check as many as apply)



American Indian or Alaskan Native

Asian

Home # ( ______) ______________ Work # ( _____ ) _____________



Black or African American

White

Optional Items (Your day camp may offer some or all of the follow-



Hawaiian or Pacific Islander

ing options. Please refer to their flyer for more information.)



Other. Please specify ______________________________________________

The registrant’s ethnic background is (please check one)

Try-It/Badge Choice (If applicable, see specific day camp



Hispanic or Latina

Not Hispanic or Latina

description. List in order of preference.)

Parent/Guardian Permission

1st choice _________________________________________________

As a legal guardian I give permission for the registrant to participate in all phases of

camp activities and off-site trips. I understand that it is my responsibility to inform

2nd choice ________________________________________________

the day camp of activities that my camper may not participate in. I understand and

agree to cooperate with all regulations. I will not allow registrant to attend if not in

3rd choice _________________________________________________

good physical condition. In an emergency, when the undersigned or other person

named cannot be reached, I give permission for the camp authorities to take any

Rainbow Program (last level completed, see specific day camp

emergency measure deemed appropriate. It is understood that all reasonable efforts

description for guidelines and availability of this option):

will be made to contact the parent/guardian.

___________________________________________________________

I understand that when participating in Girl Scout activities the registrant may be

photographed for print, video or electronic imaging. I understand that the images

Overnight :



Yes

may be used in promotional and fund raising materials, news releases and other pub-

lished formats, and will be the sole property of Girl Scouts of Oregon and Southwest

Bus Stop (if applicable, see day camp description):

Washington, its assigns or successors, or Girl Scouts of the USA.

___________________________________________________________



I wish to opt in to GSUSA/GSOSW

Texts

Emails



T-Shirt Size



May NOT be photographed for Girl Scout publicity purposes

Youth:

Med

Lrg



Adult:

Med

Lrg

XXL

X __________________________________________________________________

Signature of Parent or Guardian

Date

Cookie/Nut Credits: Use this section to record your 19-digit

THIS FORM CANNOT BE PROCESSED WITHOUT THE SIGNATURE OF A

Cookie/Nut Credit card number and 8-digit PIN. Cookie/Nut

PARENT OR GUARDIAN.

Credits may only be used by the girl who earned them.



I may be interested in helping at camp. Please contact me with information

on volunteer opportunities.

Amount to be used $ ____________________

card #

PIN #

Day Camp Camper Registration Form

Related Articles

Related forms

Related Categories