1. Camp Planet! 2013 Registration

This is a short registration form for your child to attend Camp Planet! on March 25th-March28th at Herndon Elementary School in Herndon, VA. Please answer every question and then you will get a confirmation e-mail that your daughter has been placed in camp.

* 1. Child's FIRST Name

* 2. Child's LAST Name

* 3. Age:

* 4. Date of Birth:

* 5. Address:

* 6. Mother/Guardian:

* 7. Father/Guardian:

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

* 9. Emergency Contact Information:

* 10. Current School Attending:

* 11. Are you currently registered as a Girl Scout?

* 12. Please select one bus stop or chose the "no bus" option. If your daughter's elementary school is not listed, please chose the bus stop that you can drop her off at:

* 13. 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.

* 14. Registrant's Ethnic Background:

33% of survey complete.