troop group program registration - girl scouts › content › dam ›...
TRANSCRIPT
.......................
.......................
TROOP/GROUP PROGRAM EVENT REGISTRATION
Girl Scouts of the Desert Southwestwww.gsdsw.org
• r tneve daer ot erus eB egistration details before registering. Please print clearly with blue/black ink or type. Forms cannot be transferred from one event to the next.• Incomplete registration forms will not be processed .tneve hcae rof detelpmoc eb tsum mrof noitartsiger enO .• Full payment must accompany registration form unless deposit option listed in event details. • Pre-registration is necessary to ensure adequate materials are available. • No walk-ins will be accepted. No refunds will be given after the close of registration. Substitutions may be made four or more business days prior to event.• Registration for all events will close on date listed in event details, or sooner if event before registration deadline. • Only girls currently in grade listed in event details may attend event.• Tagalongs are not permitted unless noted differently on the program • I undertand that only registerered members of Girl Scouts are covered by GSDSW’s Secondary Insurance Policy.
In utilizing this form, you are agreeing to comply with all event registration procedures, and certify that all girls and adults participating in the event listed above are registered members of Girl Scouts of the USA. Parents: by signing above, you give your child permission to participate in the activity listed above.
I give permission for photographs, video, audio recording, and quotations of my child taken by authorized Girl Scouts of the Desesrt Southwest staff or their designee to be used for council publications, tv, or the World Wide Web. Also I acknowledge my daughter may be surveyed before and after the event to evaluate her experience.
Signature of Leader/Adult in Charge .................................................................................................................................................. Date ..........................................................
5/12/14
AGRE
EMEN
TPA
RTIC
IPAN
T LI
ST
Troop/Group# ...................................... Troop Age-level D B J C S A
..............................................................................................................................................................................................................................................................................Adult Contact Name tsaL elddiM (Leader or Adult in Charge at event)
..............................................................................................................................................................................................................................................................................Apartment Number sserddA gniliaM
..............................................................................................................................................................................................................................................................................Zip Code etatS ytiC
..............................................................................................................................................................................................................................................................................Cell Phone/Pager Number enohP yaD
.......................................................................................................................... Yes, I will help Council use resources wisely and receive my via e-mailE-mail Address
( ) ( )
TROO
P IN
FO
• Consider using priority mail to ensure timely receipt.• Allow up to 10 days for delivery recommended
INST
RUCT
IONS
SUBM
IT
Event Name....................................................................................................................................... Date.................................................. Time(s)..............................................
FEES Participan F x gnidnettA# st ee/p latoT= nosre
Girls ....................... ....................... $.......................
Adults ....................... ....................... $
TOTAL ....................... ....................... $
EVEN
T
TOTAL FEE (unless deposit option listed in details)
$...............................................
PAYM
ENT
INFO
Name on Credit Card ...................................................................................................................................................................................................................................................
Credit Card # .......................................................................................................................................................................Expiration Date (MM/YY)........................................
Signature ...............................................................................................................................................................................................................................................................................
card. You agree to pay this amount pursuant to the agreement you have with your credit card provider.
List all event participants; include all information requested. If additional space is required, attach additional sheets. Incomplete registration forms will not be processed. NAME G/A DOB GRADE PARENT SIGNATURE Accommodations needed, if any (accessibility, medical, dietary, interpreter, etc.)
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
PERMISSIONS(Respond Y for Yes, N for No)
MEDICAL PHOTO
$ ........................Cash
$ ........................Check (payable to Girl Scouts)
$ ........................Desert Dollars
$ ........................Credit Card VISA, MasterCard, Discover, AmEx
DELIVER/DROP-OFFAny service center. For addresses, visit www.gsdsw.org
How did you hear about this event?Online
Check here if additional sheet is used.
Word of mouthTroopFlyer (Where did you receive
Other(Please specify)
...................................................................................
(If Needed)
T-SHIRT SIZE
FAX• Must pay with Credit Card• GSDSW cannot receipt of FAX• Please mail original form once fax is sent• See for details.
Security Code (CVV) ..................
PART
ICIP
ANT
LIST
List all event participants; include all information requested. If additional space is required, attach additional sheets. Incomplete registration forms will not be processed. NAME G/A DOB GRADE PARENT SIGNATURE Accommodations needed, if any (accessibility, medical, dietary, interpreter, etc.)
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
.............................................................................. ............ ................. ................ .............. ............. ............. .................................................. ....................................................................................
PERMISSIONS(Respond Y for Yes, N for No)
MEDICAL PHOTO
Check here if additional sheet is used.
(If Needed)
T-SHIRT SIZE
TROOP/GROUP PROGRAM EVENT REGISTRATIONAdditional Participants List
Girl Scouts of the Desert Southwestwww.gsdsw.org