Family Camping Weekends - Registration Form - 2016
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12016 Family camping weekends
registration form
Someone in family must be a registered member of Girl Scouts of Central Indiana.
A family consists of individuals living in same household.
Name ________________________________________________________________________________________________________________
Home phone ____________________________Work phone _______________________ Cell phone ___________________________
E-mail address __________________________________________Address ______________________________________________________
City _________________________________________________ State ________ County ______________________ZIP _________________
Name of registered Girl Scout member ___________________________________________________ Troop number ________________
Is this your first time to attend family camp weekends?
Please list the name, gender, age, and relationship to Girl Scout
member of each person attending:
q
q
Yes
No
Name
Gender Age
Relationship
q
Weekend at Camp Na Wa Kwa (July 1-4)
_________________________________________________________
q
Labor Day Weekend at Camp Gallahue (Sept 2-5)
_________________________________________________________
Type of facility
Fees are per weekend. Please number in order of preference if
_________________________________________________________
more than one choice.
_________________________________________________________
Camp Na Wa Kwa
____ Four tent units • Fee per family: $55
_________________________________________________________
____ One cabin unit (Deerpath) • Fee per family: $55
_________________________________________________________
____ Primitive camping site • Fee per family: $25
_________________________________________________________
Camp Gallahue
Registration must be received at the Girl Scout Service Center
____ Hillcrest • Fee per wing: $125
at Indianapolis prior to camping weekend to verify Girl Scout
____ Four tent units • Fee per family: $50
membership.
____ Adirondack Unit (Harley’s Hill)• Fee per family: $25
Please check if you need American Disabilities
____ Primitive camping site • Fee per family: $25
Act assistance.
No refunds for family camp weekends.
Total enclosed $ _______________________________
Total number of people attending __________________
Please read carefully & sign below: We take full responsibility for any action of all members of our family. We also agree to be
responsible for the waterfront safety for our family and to have one adult with our children at the waterfront area whenever they
are swimming, boating, or playing near the waterfront area. We understand Girl Scout accident insurance is part of the annual troop
registration fee; therefore, only registered members are covered by Girl Scout accident insurance.
Adult signature ___________________________________________________________________________ Date ________________________
Payment information:
q
q
q
q
MasterCard
Visa
American Express
Discover (American Express, Discover can not be used for online
registration. Registration must be completed on paper registration form.)
Card number _____________________________________________ Expiration date _____________ Amount to be charged $ _________
Name of credit card holder __________________________________________ Signature _________________________________________
For office use only
$ _______________________
Amount enclosed
q
Cash
Receipt to:
q
________________________
Check #
10-83-6230-3510 (Camp NaWaKwa, July 1-4)
q
Charge
10-83-6230-3210 (Camp Gallahue, Labor Day)
Additional forms are available at any Girl Scout service center, by calling 317.924.6800 or 855.GSCIN.4U, on our website at , or forms
may be duplicated.
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