Specialty Camp Registration Form - Girl Scouts Of The Missouri Heartland Page 2
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1
2Participants/Attendees
NOTE: Camp is designed for specific numbers and ages of participants.
Registered
Payment Method(s)
First & Last Names of Children
Gender
Grade
Age
City
Girl Scout?
Fin.
Cookie
Cash/
(M/F)
(under age 18)
+
Asst.*
Check
Credit
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Names of Adults
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
TOTAL
$
$
$
$ 0
$ 0
$ 0
*Financial Assistance is only available to registered Girl Scout members.
+
Girl Scout Cookie Credit may only be used to pay for the Girl Scout who earned it.
___________________
Please share if any person(s) in troop/group has special needs (e.g., allergies):
____________________________________________________________________________________
____________________________________________________________________________________
This form, and any applicable camp fees, must be received 2 weeks prior to your camp session. To
ensure that your registration is only processed and charged once, please use only one of the following
submission methods:
Fax to 417-862-4120 (must include credit card number for payment)
Email to
(must include credit card number for payment)
Mail to a GSMH service center
Walk in to a GSMH service center
For updated service center mailing addresses and hours, please visit
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P:\Forms\Public\External\Resident Camp\Specialty Camp Registration 341915
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