If you are enrolling more than one daughter, please complete a separate form for each.

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* 1. Parent Name and Address

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* 2. Parent's Primary Email Address

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* 3. Secondary Email Address (optional) 

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* 4. Emergency Contact Number

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* 5. Secondary Emergency Contact Number (optional)

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* 6. Daughter's FIRST Name

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* 7. Daughter's LAST Name

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* 8. Daughter's Birthdate

Birthdate

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* 9. Daughter's Grade as of September 2019

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* 10. School Attending in September 2019

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* 11. Daughter's t-shirt size

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* 12. Does your daughter have any allergies or special needs?

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* 13. Is your daughter in Girl Scouts?

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* 14. If yes, what Girl Scout Troop Number?

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* 15. How did you hear about the program?  (select all that apply)

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