Girl Scout Patch Program Activity Log Sheet Page 4
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4GIRL SCOUT PATCH PROGRAM ACTIVITY LOG SHEET
To earn your Water Conservation Patch, use this log sheet to keep track of the completion of
requirements and to provide your leader with evidence of the completed requirements and
checklist. When complete send this form and information to the address below. Please allow
two to three weeks to receive your patch. Please write legibly.
Name-
Level 1
Level 2
Level 3
Date Completed
Please Print!!!!
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Please include the following information when returning this sheet
Group Leader’s Name: ________________________________Troop#___________________
Mailing Address: _____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Phone Number for questions: ___________________________________________________
Mail your completed log sheet to the City of Pflugerville, Water Conservation Program,
C/O Public Works Department at P.O. Box 589, Pflugerville, Texas 78691. If you have any further
questions, please contact Patricia at 512-990-6400 or email:
pwwaterconservation@pflugervilletx.gov
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