DAY CA MP RE GI ST RAT I O N FO RM
R EG IS TR AT IO
Use this form for all girls in grades K-6, PAs & APLs (Registration for all PAs/ APLs is $15). Please note that you may also elect to use the Council Online Registration Access (CORA) available at www.gsoh.org if the attendee is a currently registered Girl Scout.
PLEASE PRINT IN BLUE/BLACK INK COMPLETE THIS ENTIRE PAGE
REGISTRATION FOR (age 13+ & completed grade 7 by June 2016) (age 14+, completed grade 8 by June 2016 & completed PA 1) (age 15+, completed grade 9 by June 2016, completed PA 1 & 2.) PA email address __________________________________________________________________ PA cell phone ____________________________________________________________________
Girl’s name _______________________________________________ Current Grade ____________________ Street address ______________________________________________________________________________ City _____________________________________________________ State ___________ ZIP_______________ Home phone _______________________________________________________________________________ Parent email address ________________________________________________________________________ CAMP SESSION DETAILS Name of day camp ____________________________________________ Session dates ________________________________________________ Buddy name* __________________________________________________
T-SHIRT SIZE (circle): Child (SM 6-8) (MED 10-12) (LG 14-16) Adult (SM) (MED) (LG) (XL) (2XL)
*Girls can request ONE buddy. Requests for multiple buddies will not be honored. Every effort will be made to pair your camper with her buddy or troop, but it is not guaranteed.
NEW MEMBER? All you need to do is attach the Membership Registration Form and your membership fee! The form can be found at www.gsoh.org. Fees
Amount Due
Registration fee
= ___________
Bus fee (if applicable)
MAKE CHECKS PAYABLE TO: Girl Scouts of Ohio’s Heartland Council, Inc. OR complete below if you wish to charge your deposit to Visa, MasterCard, Discover or American Express (deposit fee is non-refundable).
$50.00 = ___________ Total Due $ = ___________
VISA
DISCOVER
AMERICAN EXPRESS
$
If you register before the deadline, you will receive a t-shirt.
Amount
Make check payable to: Girl Scouts of Ohio’s Heartland Council, Inc.
Expiration date
Mail to: Girl Scouts of Ohio’s Heartland Council, Inc. 1700 WaterMark Drive Columbus, OH 43215-1097 Fax: 614-487-8189 Phone: 614-487-8101
MASTERCARD
Billing address
Account number (typically 16 digits)
Signature of card holder (required for credit card payments)
City
State
ZIP
Date
N