Community Partner Application Survey

1. Name of Organization

Name of Organization

2. Website

Website

3. Organization Type

Organization Type Non-Profit

For Profit

4. Contact Person

Contact Person

5. Title

Title

6. Email Address

Email Address

7. Address

Address Street
City
State
Zip

8. Phone Number

Phone Number

9. Fax

Fax

10. Name of Event

Name of Event

11. Location

Location

12. Event/Activity

Event/Activity Capacity
Minimum # of girls
Maximum # of girls

13. Provide a brief description about your organization or business:

Provide a brief description about your organization or business:

14. What kind of program activity/event would you provide for Girl Scouts? Give a brief description.

What kind of program activity/event would you provide for Girl Scouts? Give a brief description.

15. Community Partner Promotion Options

Community Partner Promotion Options Option 1: Online Listing for twelve month posting (Non-profit organization $25; For-Profit business $75)

Option 2: Community Partner Flyer Distribution (One time distribution: Non-profit $75; One time distribution: For-profit $100; Three- time distribution: Non-profit $175; Three-time distribution: For-profit $250)

Option 3: E-Newsletter Distribution (Non-profit $25 per e-news mailing; For-profit $50 per e-news mailing)

16. We agree to submit promotional content for approval at least ten business days before producing the final publication for distribution.

We agree to submit promotional content for approval at least ten business days before producing the final publication for distribution. Yes

17. As a community partner with Girl Scouts of Manitou we agree to:

As a community partner with Girl Scouts of Manitou we agree to: Have all marketing materials approved by Girl Scouts of Manitou prior to printing final publication.

Provide outlines/curriculum for activities to be completed at event.

Provide Girl Scouts of Manitou with reports of participation rate for each program activity/event held by community partner by December 1 of each year.

18. Community Partners must provide their own health and accident insurance for their members, volunteers, and staff. Girl Scouts of Manitou is not responsible for providing this coverage and assumes no responsibility in the event of bodily injury.

Community Partners must provide their own health and accident insurance for their members, volunteers, and staff. Girl Scouts of Manitou is not responsible for providing this coverage and assumes no responsibility in the event of bodily injury. In submitting this form I agree to the terms of this agreement understand that Girl Scouts of Manitou has the right to discontinue an activity or event at any time if the Community Partner violates any terms of this agreement.

19. Name of Community Partner Representative

Name of Community Partner Representative

20. Date form submitted

Date form submitted

Community Partner Application

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