Day Camp Application And Financial Assistance Request Form printable pdf download

Girl Scouts – North Carolina Coastal Pines Day Camp Application

Please complete this form for the person who is applying to Day Camp. Each person who will be attending/participating at Day Camp

must complete a registration (including Day Camp volunteers (must be registered members and have current background check, PAs,

Pixies/Tagalongs, etc). Number of participants at Day Camp is dependent on number of qualified volunteers and location limitations.

Registrant’s Name

grade (in Fall)

Address

Phone (h)

(c)

Guardian’s Name

Guardian’s email

Emergency Contact (other than guardians)

Emergency Contact Phone (h)

(c)

Fees

(please refer to specific day camp for fees and offerings – including t-shirts, sizes and add-ons)

Day Camp

Location

Day Camp Fee (Check unit if applicable) ........................................................................................................... $

 Daisy Brownie Junior  Cadette Pixie PA (Core)  PA (Specialty)  PA VIT

Adult Volunteer

Girls (K-12) and adults must be current Girl Scout members. Include $25 fee if not currently registered

T-shirt (included-not all day camps offer this option)  YS YM YL AS AM AL AXL  A2X A3X

T-shirt (extra, if applicable – not all day camps offer this option) ................................................................... $

-O

(

–

)

IF APPLICABLE

NOT ALL DAY CAMPS OFFER THESE OPTIONS

Before Care ....................................................................................................................................................... $

After Care .......................................................................................................................................................... $

Overnight .......................................................................................................................................................... $

Total paid

 Cookie Dough/Gift Card-please apply $

from

Cookie Dough/Gift Card number

exp.

 Financial Aid request

 Paper Application Attached

 Application completed online

Volunteer

Day camp cannot happen without caring, trained volunteers. If you would like to help girls discover the fun and excitement of Day

Camp and are not already a Day Camp volunteer, check yes! and and spend a week (or as much time as you have to give)

volunteering at Day Camp.

 Yes, I would like to volunteer for this Day Camp

 No, I cannot volunteer for this day camp

Day Camp Authorization

I have read the general information regarding day camp, and agree to cooperate fully with day camp staff in regards to camp policies and

procedures. I further understand that my child may be traveling off of camp property for one or more field trips, but will not do so without proper

advance notification.

As parent/guardian, I will be responsible for ensuring that my child is dressed appropriately and brings the required supplies, and that she will only

attend if she is in good physical condition and health. I further understand that if my child should need to miss one or more days of camp due to

illness that I am not eligible for any kind of refund for that period.

All day camp activities will be conducted in accordance with GSUSA/GSNCCP guidelines regarding safety and adult supervision.

Guardian’s Signature

Date

Updates 01.2018