Day Camp Camper Registration
form #870 • 04/19 • page 1 of 1
Check how camper will be participating:
Daisy (K-1) Brownie (2-3) Junior (4-5) Cad (6)
Child of Camp Staff Program Aide-In-Training Program Aide
Parent/Guardian #1 (that lives with camper/same address)
Name ___________________________ Cell # ( ___ ) _________
Home # ( _____ ) ___________ Work # ( ____ ) ____________
Email ________________________________________________
Parent/Guardian #2
Name ___________________________ Cell # ( ___ ) _________
Home # ( _____ ) ___________ Work # ( ____ ) ____________
Email ________________________________________________
Emergency Contact (other than Parent/Guardian #1 or #2)
Name ____________________________ Relation ____________
Home # ( _____ ) ___________ Work # ( ____ ) ____________
Optional Items (Your day camp may offer some or all of the fol-
lowing options. Please refer to their flyer for more information.)
Try-It/Badge Choice (If applicable, see specific day camp
description. List in order of preference.)
1st choice ____________________________________________
2nd choice ___________________________________________
3rd choice ____________________________________________
Rainbow Program (last level completed, see specific day camp
description for guidelines and availability of this option):
_____________________________________________________
Overnight: Yes No
Bus Stop (if applicable, see day camp description):
____________________________________________________
T-Shirt Size Youth: Sm Med Lrg
Adult: Sm Med Lrg XL XXL
A fully completed, signed registration packet must be accompanied by these 3 things: 1) Completed
“Day Camp Health History & OTC Medications”, 2) camp payment, and 3) PA/CIT Application (If
applicable). Send all to the address listed on your day camp information page. A completed regista-
tion packet does not guarantee camper placement. Contact the day camp registrar with questions.
DO NOT mail registrations to the Girl Scout service centers.
Membership
My camper is a registered Girl Scout for the current membership year or I will
register her online. I will pay the camp fee only.
My camper is new or needs to renew her membership. I will pay Girl Scout
day camp fee + $25.00 membership dues. This will register her as a Girl
Scout through September 30 of this year. (Up to five months of membership)
My camper is a new member. I will pay Girl Scout day camp fee + $35.00
membership dues. This will register her as a Girl Scout through September
30 of next year. (Up to 17 months of membership)
Acceptance and participation in summer programs is the same for everyone with-
out regard to race, color or national origin. As an equal opportunity organization,
Girl Scouts is dedicated to diversity and fully supports the right of equal access
for girl and adult members with disabilities. Girl Scouts of Oregon and Southwest
Washington makes every reasonable effort to ensure this access.
The information below will be used by Girl Scouts of the USA for statistical purposes
only and to help improve outreach efforts and advance the Girl Scout Movement.
The registrant’s racial background is (please check as many as apply)
American Indian or Alaskan Native Asian
Black or African American White
Hawaiian or Pacific Islander Other
The registrant’s ethnic background is (please check one)
Hispanic or Latina Not Hispanic or Latina
Parent/Guardian Permission
As a legal guardian I give permission for the registrant to participate in all phases of
camp activities and off-site trips. I understand that it is my responsibility to inform
the day camp of activities that my camper may not participate in. I understand and
agree to cooperate with all regulations. I will not allow registrant to attend if not in
good physical condition. In an emergency, when the undersigned or other person
named cannot be reached, I give permission for the camp authorities to take any
emergency measure deemed appropriate. It is understood that all reasonable efforts
will be made to contact the parent/guardian.
I understand that when participating in Girl Scout activities the registrant may be
photographed for print, video or electronic imaging. I understand that the images
may be used in promotional and fund raising materials, news releases and other
published formats, and will be the sole property of Girl Scouts of Oregon and South-
west Washington, its assigns or successors, or Girl Scouts of the USA.
I wish to opt in to GSUSA/GSOSW Texts Emails
May NOT be photographed for Girl Scout publicity purposes
X ______________________________________________________________
Signature of Parent or Guardian Date
THIS FORM CANNOT BE PROCESSED WITHOUT THE SIGNATURE OF A
PARENT OR GUARDIAN.
I may be interested in helping at camp. Please contact me with information
on volunteer opportunities.
Day Camp _________________________________ Camper Name ___________________________________________
Mailing Address _____________________________________ City ______________________ State _____ZIP _______
Guardian ______________________________________ Buddy Name (if applicable) ______________________________
Age _____ DOB ___________Grade Next Fall ______School Next Fall _________________________________________
Cookie/Nut Credits: Use this section to record your 19-digit
Cookie/Nut Credit card number and 8-digit PIN. Cookie/Nut
Credits may only be used by the girl who earned them.
Amount to be used $ __________________
card # PIN #
All campers must be registered Girl Scouts for the current membership year.
Visit girlscoutsosw.org to become a member. Financial assistance for Girl Scout
membership is available.
click to sign
signature
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