Name
Address
State
City
Postal/Zipcode
Girl Email Address
Parent / Guardian contact number
Girl Cell Phone number
(only if 13 and older)
Date of birth
Number of years as a Girl Scout
School grade
Name of school
Custodial Care
Parent / Guardian Name
Address
State
City
Postal/Zipcode
Email Address
Cell number
Emergency Contact Person
Emergency Contact Number
Do you agree to register your girl in Girl Scouts program?
Signature of Parent/Guardian