day and resident camp • summer 2013 - Girl Scouts San Diego

To register a camper in any day or resident camp, use this form or download one at www.sdgirlscouts.org.
Please make a copy for your records and mail the completed form with payment to Girl Scouts, 1231 Upas Street, San Diego, CA 92103 or fax form to 619-795-6930.
Please type or print legibly, complete, sign, and mail with deposit. Day Camp Resident Camp
Last name First name Middle initial
Mailing address City State Zip
Phone Grade in Fall 2013 Birthdate Troop # (if appl.)
E-mail address
2013 SUMMER CAMP REGISTRATION
31
Camper is in the custodial care of (check one) Both parents Mother only Father only Other
Custodial parent/guardian name Daytime phone
Home address (if different from above)
Second parent/guardian name Daytime phone
Home address (if different from above)
Current Girl Scout member? Yes Girl Scouts San Diego Yes Other council No (please add $12 fee below)
CAMP SESSION INFORMATION You may register for three weeks of camp per form.
Dates of camp First Choice Camp Name Second Choice Camp Name
Camp friend (if applicable). Mail registration forms and deposits together. Please place my camper with
Does your camper have special needs (dietary, medical, learning, emotional, etc.)? Yes No If yes, please describe:
T-shirt size: Child S M L RESIDENT CAMP ONLY: My camper will take the bus ($15 fee): Yes No
Adult S M L XL XXL XXXL Bus location: Balboa (South County) Escondido (North County)
DAY CAMP: My camper will take the bus (if applicable) Yes No
I am interested in applying to become a day camp volunteer. My child is a Girl Boy Preschooler
PAYMENT INFORMATION
Session fee: (Choose tier that best fits your family) $
Girl Scout membership fee $12 $
(If camper is not already a current member.)
Resident camp only $15 bus fee $
I’d like to make a tax-deductible gift to send $
other girls with financial difficulties to camp:
METHOD OF PAYMENT
$50 (non-refundable) deposit per camp must be included with registration or it will
be returned as incomplete.
Check enclosed made payable to GSSD $
Cookie Bucks enclosed (original certificate). May not
be used for deposit. $
Charge my credit card this amount $
Total balance due: $
VISA MC AMEX DISCOVER
I give permission for my camper to attend and to participate in Account # Exp. date
all phases of this program, including field trips, if applicable. I
give permission for my daughter to be registered as a member Cardholder’s name (print)
of Girl Scouts. I give permission for Girl Scout staff to take photos
and/or video of my camper for sharing with camp families Cardholder’s signature
and/or for publicity purposes.
I do NOT wish for my daughter to be photographed for
publicity purposes.
Correspondence is generally by e-mail. I prefer to have forms mailed to me.
Parent/Guardian signature Date
ss:mlm
PGO-1787 12/20/12