Download - Girl Scouts in the Heart of Pennsylvania
Download - Girl Scouts in the Heart of Pennsylvania
Download - Girl Scouts in the Heart of Pennsylvania
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Troop Adventure Camp Form<br />
Please pr<strong>in</strong>t clearly <strong>in</strong> blue or black <strong>in</strong>k. Please fill <strong>in</strong> all <strong>in</strong>formation and mail payment <strong>in</strong> full to: GSHPA, Attn: Registrar, 350<br />
Hale Avenue, Harrisburg, PA 17104<br />
Contact Information<br />
Leader Name______________________________________________________Troop #______________________<br />
Address_______________________________________________________________________________________<br />
City________________________________________State__________________ZipCode_____________________<br />
Daytime Phone______________________________ Even<strong>in</strong>g Phone______________________________________<br />
Email Address:_________________________________________________________________________________<br />
Fall <strong>of</strong> 2012 <strong>Girl</strong> Scout Level<br />
Daisy: K 1 st Grade Brownie: 2 nd Grade 3 rd Grade<br />
Junior: 4 th Grade 5 th Grade Cadette: 6 th Grade 7 th Grade 8 th Grade<br />
Senior: 9 th Grade 10 th Grade Ambassador: 11 th Grade 12 th Grade<br />
Multi-Level (how many) ____D ____B ____J ____C ____S ____A<br />
TAC Program<br />
These programs have a very limited capacity. Ratios will be strictly enforced.<br />
Summer Time Fun Summer End Celebration Daisies Day<br />
June 15-17, 2012 August 3-5, 2012 July 7, 2012<br />
If <strong>the</strong> program is full, please:<br />
Return my Registration<br />
Place my troop on <strong>the</strong> wait<strong>in</strong>g list<br />
Place my troop <strong>in</strong> <strong>the</strong> alternative program:____________________<br />
Payment Information<br />
Attendance Total<br />
How many total girls attend<strong>in</strong>g __________ X $_________ = $___________<br />
How many total adults attend<strong>in</strong>g ___________X $________ = $____________<br />
Total Enclosed<br />
= $____________<br />
Payment Type<br />
Check Check #: Amount Enclosed:<br />
Credit Card Visa Mastercard Discover<br />
Account #:<br />
Expiration Date:<br />
CCV (code on back)<br />
Amount to be charged:<br />
Money Order Money Order #: Amount Enclosed:<br />
I have read and understand <strong>the</strong> program registration <strong>in</strong>formation and have <strong>in</strong>cluded a troop roster on<br />
<strong>the</strong> back <strong>of</strong> this registration form. The payment <strong>in</strong> full is also enclosed with this registration.<br />
_____________________________________________________________________________________<br />
Signature<br />
Date<br />
2012 Summer Camp – TAC Registration Form rev. 12/11<br />
27
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