Girl Scouts Registration Form

Hello! Welcome to the Girl Scouts registration form. Our girls enjoy camping and hiking, community service projects.

Questions for Girl Scouts Registration Form

1.

Name

The answer should be a text input.
2.

Address

The answer should be a text input.
3.

State

The answer should be a text input.
4.

City

The answer should be a text input.
5.

Postal/Zipcode

The answer should be a number input.
6.

Girl Email Address

The answer should be a email input.
7.

Parent / Guardian contact number

The answer should be a phone number.
8.

Girl Cell Phone number

(only if 13 and older)

The answer should be a phone number.
9.

Date of birth

The answer should be a date input.
10.

Number of years as a Girl Scout

The answer should be a text input.
11.

School grade

The answer should be a text input.
12.

Name of school

The answer should be a text input.
13.

Custodial Care

The answer should be a single choice:
  1. Both parents
  2. Mother/guardian only
  3. Father/guardian only
  4. Other
14.

Parent / Guardian Name

The answer should be a text input.
15.

Address

The answer should be a text input.
16.

State

The answer should be a text input.
17.

City

The answer should be a text input.
18.

Postal/Zipcode

The answer should be a text input.
19.

Email Address

The answer should be a email input.
20.

Cell number

The answer should be a phone number.
21.

Emergency Contact Person

The answer should be a single choice:
  1. Father
  2. Mother
  3. Guardian
  4. Other
22.

Emergency Contact Number

The answer should be a phone number.
23.

Do you agree to register your girl in Girl Scouts program?

The answer should be a single choice:
  1. I agree
  2. I disagree
24.

Signature of Parent/Guardian

The answer should be a signature.

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