Girl Event Registration Form Individual - Girl Scouts Of Eastern South Carolina

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Girl Scouts of Eastern South Carolina
Girl Event Registration Form---Individual
This registration form is used for any event which an individual girl wishes to register for.
The girl may be registered as a Girl Scout Juliette (individually registered Girl Scout) or be
a member of a troop. Individual girls may attend/participate in Girl Scout events if a parent
or guardian attends with them, unless otherwise stated. The parent/guardian must be a
registered Girl Scout adult.
Event Name: _____________________________________________________________________________
Date of Event: ________________________________ Time of Event: ______________________________
Girl’s Name: _____________________________ Age: _________ Grade Level:
D
B
J
C
S
A
Phone: ______________________________
E-mail Address: ____________________________________
Mailing Address: __________________________________________________________________________
City: ______________________________________________________ State: _______ Zip: ___________
How would you like to receive your confirmation?
Postal Mail
E-mail
Registered as a member of Troop # _______ or as a Girl Scout Juliette member ______________
A registered Girl Scout adult parent/guardian must accompany an individual Girl Scout to an event.
Name of adult attending the event:
_____________________________________________________________________
Is the contact information for the adult the same as for the girl?
Yes
No
If no, please list contact information: ___________________________________________________________
Girl Event Fee: ____________
Adult Event Fee: ___________ Total Included: ________________
Please Circle Payment Type
Cash
Check
Credit Card
Credit Card #__________________________________ Exp. Date _______
Security Code (3 or 4 digits on back of card) _______
Registration must be received in the North Charleston Service Center with payment to be processed. Submit the
registration form by the registration deadline in event description to: North Charleston Service Center, 7257 Cross
County Road, North Charleston, SC 29418. Fax 843-552-6221
Please use the reserve side of this form to include any information we need to know about your girl.
I understand that the event fee(s) are non-refundable and all persons attending must be registered members of Girl
Scouts of the USA.
Signature: _____________________________________________________
Date:
For Office Use:
Date
Receipt #
Posted By ___________________
Cash $
Check $
Credit Card $___________

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