1. Camp Like A Girl 2014

This is a short registration form for your child to attend Camp Like A Girl June 23-27, 2014 at Cacapon Resort State Park in West Virginia. Please answer every question on this form. You will receive a confirmation e-mail once registration and payment have been received.

* 1. Child's First Name:

* 2. Child's Last Name:

* 3. Age:

* 4. Date of Birth:

* 5. Address:

* 6. Current School Attending:

* 7. Parent/Guardian:

* 8. Parent/Guardian 2:

* 9. If divorced or legally separated, please indicate the custodial parent(s):

* 10. Emergency Contact Information and Additional Individuals Authorized to Pick Up (not listed above):

* 11. Please list any additional people, beyond those already listed, who are authorized to pick up your daughter.

* 12. Are you currently a registered Girl Scout?

* 13. How will your daughter be getting to camp?

* 14. Which bus stop will your child use?

* 15. For security reasons, we need an adult at every bus stop. Is this something you can do?

* 16. Registrants Racial Background is:
We encourage you to voluntarily to provide the following information on racial background and ethnicity. This information will be used by Girl Scouts of the USA to help improve outreach efforts and advance the Girl Scout movement.

* 17. Registrant's Ethnic Background:

 
33% of survey complete.

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