Camp Summer Adventure 2013

1. Camp Summer Adventure 2013

This is a short registration form for your child to attend Camp Summer Adventure from
Monday, June 24 - June 28, 2013 Camp Summer Adventure will be held at Excel Academy Public Charter School, SE Washington, DC

Closest Metro station: Anacostia on the Green line

Please answer every question and then you will get a confirmation e-mail that your daughter has been placed in camp.

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* 1. Child's Name and Last Name:

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* 2. Age:

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* 3. Date of Birth:

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* 4. Address:

Address:

Apartment Number:

City:

State:

ZIP Code:

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* 5. Current School Attending:

Name:

State:

Grade:

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* 6. Mother/Guardian:

Name:

Phone Day:

Phone Evening:

Phone Cell:

e-mail:

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* 7. Father/Guardian:

Name:

Phone Day:

Phone Evening:

Phone Cell:

e-mail:

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

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* 9. Emergency Contact Information:

Name/Relationship:

Phone:

Name/Relationship:

Phone:

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* 10. Are you currently a registered Girl Scout?

Yes

If yes, troop #:

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* 11. Girls currently participating in a troop will be placed on a waitlist for admission into camp.

Provide the name of the invited Non-Girl Scout.

Other (please specify)

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* 12. Do you need Bus Transportation?

Yes

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* 13. Which bus stop will your child use?

Ideal Academy PCS, North Capitol Campus

Plummer Public School

Moten Public School

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* 14. 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.

American Indian or Alaskan Native

Asian

Black or African American

Hawaiian Pacific Islander

White

Other (please specify)

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* 15. Registrant's Ethnic Background:

Hispanic or Latina

Not Hispanic or Latina

33% of survey complete.

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* 1. Child's Name and Last Name:

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* 2. Age:

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* 3. Date of Birth:

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* 4. Address:

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* 5. Current School Attending:

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* 6. Mother/Guardian:

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* 7. Father/Guardian:

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

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* 9. Emergency Contact Information:

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* 10. Are you currently a registered Girl Scout?

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* 11. Girls currently participating in a troop will be placed on a waitlist for admission into camp.

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* 12. Do you need Bus Transportation?

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* 13. Which bus stop will your child use?

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* 14. 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.

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* 15. Registrant's Ethnic Background:

* 14. 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.