Girl Scout Membership Form

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Girl Membership
GIRL SCOUT MISSION
Girl Scouting builds girls of courage,
Join the global network of 2.6 million Girl Scouts
confidence, and character, who
Membership year through 9/30/2018
make the world a better place.
FUN WAYS TO PARTICIPATE
Check one:
� New Member
� Renewing Member
� GSUSA ID (if known)
(Check all that interest you.)
� Camp: Connect with nature.
Choose a camp by day or overnight.
Name: First
Middle
Last
� Events: Focus on half- or full-
Address
Apartment
day events to share your passions.
(
)
City
State / Zip Code
Girl Home Phone
� Series: Explore your interests
(
)
over a few sessions in a way that
Girl Cell Phone (only if 13 and older)
Girl Email Address (only if 13 or older)
I wish to opt in*: � Texts
fits your schedule.
Girl Scouts respects and welcomes people from all backgrounds and abilities. By completing the following information (as defined by the U.S.
� Travel: Pack your bags. Travel
Census Bureau), you ensure support and funding for girls in your community. Hispanic/Latina is defined as an ethnicity, not a race, therefore is
across town or around the world!
reported separately. This information is used for statistical purposes only.
� Troop: Have fun on a regular
Date of birth (mm/dd/yyyy):
/
/
Number of years as a Girl Scout:
School grade in fall 2017:
basis with your Girl Scout sisters.
Name of school:
� Virtual: Interact online with Girl
Custodial care:
She is (Check all that apply.):
She is Hispanic or Latina:
Scouts everywhere.
� Both parents
� American Indian or
� White
� Yes
� Mother/guardian only
Alaskan Native
� Other (Please specify.)
� No
� Father/guardian only
� Asian
� I choose not to share
YES! I
would like to make a
� Other
� Black or African American
� I choose not to share at
at this time.
donation today that directly
� Hawaiian or Pacific Islander
this time.
benefits girls in our area. Enclosed
is my tax-deductible donation.
� Address is same as girl’s
Check one:
Parent/Guardian (1) Name: First
Middle
Last
� $500
� $250
� $150
� $100
� $50
� $25
Address
� Other $
Employer
Occupation
PAYMENT INFORMATION
(
)
(
)
Home Phone
Business Phone
Membership Fee: $
25
(
)
wish to opt in*: � Texts
Cell Phone
Email Address
I
Donation: $
� Address is same as girl’s
Total Attached: $
� Cash
� Check*
Parent/Guardian (2) Name: First
Middle
Last
� Amex � Discover
Address
� Visa
� MasterCard
� Other
Employer
Occupation
(
)
(
)
Home Phone
Business Phone
Name on Credit Card
(
)
Cell Phone
Email Address
I wish to opt in*: � Texts
Credit Card #
Media Permission
The Girl Scout Promise
The Girl Scout Law
*By signing here and
When participating in Girl Scout activities, I
On my honor, I will try:
I will do my best to be
checking the circles
Expiration Date
(or the person I am registering) give consent
To serve God and my country,
honest and fair,
above, each signee
to be interviewed, photographed, videotaped,
To help people at all times,
friendly and helpful,
(and on behalf of the
or electronically imaged for the purposes of
And to live by the Girl Scout Law.
considerate and caring,
girl, as applicable)
Signature
promotional materials, news releases, or other
courageous and strong, and
agrees to receive
published formats for either the local Girl
When making the Girl Scout
responsible for what I say and do,
auto-dialed inform-
Date
Scout councils or Girl Scouts of the USA. The
Promise, individual members
and to
ational or marketing
images will be the sole property of the local
may substitute wording ap-
respect myself and others,
text messages at the
*Make checks payable to Girl Scouts.
Girl Scout council or Girl Scouts of the USA.
propriate to their own spiritual
respect authority,
cell number above,
I hereby release and hold harmless the local
beliefs for the word “God.”
use resources wisely,
understanding such
THANK YOU FOR
Girl Scout council and Girl Scouts of the USA
make the world a better place, and
consent is not
SUPPORTING GIRL SCOUTS!
from any claim arising from the use of
be a sister to every Girl Scout.
required to join.
these images.
Learn more about Girl Scouts at
I/We acknowledge that the registrant will accept and abide by the Girl Scout Promise and Law.
� I wish to opt out at this time.
The registrant has permission to join Girl Scouts.
Return this registration form, along
with the GSUSA membership fees
Signature of Parent/Guardian
Date
Signature of Parent/Guardian
Date
to your local council. Fees are
Council code:
Service unit/team:
Group/troop:
not refundable or transferable to
another person.
PATHWAY OF ENTRY:
� Camp
� Event
� Series
� Travel
� Troop
� Virtual

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