Camper's Name:

Mailing Address:

City/State/Zip:

Parent/Guardian:
Phone (hm): WK:

Parent/Guardian:
Phone (hm): WK:

Other Emergency Contact Name:

Phone (hm): WK:

Registered Girl Scout? Yes No
Troop Number:

Age Level in Fall: BR JR CAD SR

Grade in Fall: Birthdate:

I would like to be in the same cabin as

One Person Only

Did you register a Non-Girl Scout Friend?
Name:
$25 off your camp fee when friend registers.