Summer Camp Registration Form - Girl Scouts Of The Missouri Heartland
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2Girl Scout summer camp registrations will be accepted starting on February 29, 2016.
Girl Scout summer camp registrations will be accepted starting on February 2, 2015.
Girl Information
I prefer to receive my confirmation via email confirmation or mail confirmation.
Name __________________________________________ 5-Digit Troop Number ________________
Address __________________________________ City _______________ State _____ Zip ________
Email address
(Confirmation packet will be mailed or emailed to this address.)
□
□
2015-2016?
2016
Registered Girl Scout for 2014-2015?
Yes
No Birthdate _________ Grade in Fall 2015 ______
If no, please include membership registration fee in session fees section on back.
Parent/Guardian Information
Name _____________________________________________________________________________
Address __________________________________ City _______________ State _____ Zip ________
Home Phone (___)____________ Cell Phone ( __)_____________ Work Phone (___)_____________
E-Mail ____________________________________________________________________________
Emergency Contact Information (person to be notified in case a parent/guardian cannot be reached)
Name ________________________________________ Relationship to Camper _________________
Home Phone (___)_____________ Cell Phone (___)____________ Work Phone (___)____________
Camp and Program Session Information (Please list program sessions in order of preference.)
To take advantage of the multi-session discount, you can register for two program sessions below.
Registration 1
Registration 2
st
st
1
Camp Choice- Location
1
Camp Choice- Location
Program
Date
Program
Date
nd
nd
2
Camp Choice- Location
2
Camp Choice- Location
Program
Date
Program
Date
rd
rd
3
Camp Choice- Location
3
Camp Choice- Location
Registration 1
Program
Date
Program
Date
If a pre-requisite is required for the program session, please list camper’s experience and the year
completed: _________________________________________________________________________
Camp Buddy Information
You may list one buddy with whom your camper would like to be placed. Buddies must list each other.
Name __________________________________________ 5-Digit Troop Number ________________
Special needs/items that staff should know about the camper _____________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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