2017 Service Unit Camp Submission Form
Camper First Name:
Camper Last Name:
Pick the one that applies:
Girl (Age Eligible)
Girl (Not Age Eligible)
Teen Mentor (Program Aide/CIT, etc)
Adult Camp Committee Member
Date of Birth:
Troop Number (or IGIRL):
Girl Scout Level:
Summer camp 2016?
Yes, the camper attend one of our summer overnight or day camps in summer 2016.
No, the camper did not attend one of our summer overnight or day camps in summer 2016.
Please check if applicable: Program Aide
Please check if applicable: CIT 1
Please check if applicable: CIT II
Please check if applicable: Tag-along
Any Special Needs or Restrictions?
Parent Guardian First Name:
Parent/Guardian Last Name:
County of Residence:
Emergency Contact: Name
Emergency Contact Phone:
Parent/Guardian has given permission for the camper to become a Girl Scout for this year.
Tshirt Size- (If applicable)
No Tshirt Ordered
Patch Purchased- (If applicable)
Yes, patch was purchased,
No, patch was NOT purchased.
Amount Collected: Camp Fee:
Amount Collected: Tshirt Fee (optional):
Amount Collected: Patch fee (optional)
Amount Collected: GSUSA Annual Membership ($15):
Amount Collected: Donation to GSBDC:
Send me a copy of my responses
Your submission is being processed. Please do not close this browser window until complete.