Camp Around the World 2014

1. Camp Around the World 2014

This is a short registration form for your child to attend Camp Around the World from June 23-27, 2014 at Saunders Middle School in Virginia. Please answer every question on this form. You will receive a confirmation e-mail once registration and payment have been received.

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* 1. Child's First Name:

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* 2. Child's Last Name:

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* 3. Age:

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* 4. Date of Birth:

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* 5. Address:

Address:

Apartment Number:

City:

State:

ZIP Code:

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* 6. Current School Attending:

Name:

State:

Grade:

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* 7. Parent/Guardian:

Name:

Phone Day:

Phone Evening:

Phone Cell:

e-mail:

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* 8. Parent/Guardian 2:

Name:

Phone Day:

Phone Evening:

Phone Cell:

e-mail:

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

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

Name/Relationship:

Phone:

Name/Relationship:

Phone:

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

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* 12. Are you currently a registered Girl Scout?

Yes

If yes, troop #:

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

Parents/Guardians will pick up and drop off every day

She will be riding the bus every day

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* 14. Which bus stop will your child use?

Occoquan Elementary

Featherstone Elementary

Leesylvania Elementary

Bel-Air Elementary

Neabsco Elementary

Mary William Elementary

Montclair Elementary

Pattie Elementary

Dumfries Elementary

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

Morning ONLY

Afternoon ONLY

Morning AND Afternoon

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* 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.

American Indian or Alaskan Native

Asian

Black or African American

Hawaiian Pacific Islander

White

I choose not to share

Other (please specify)

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* 17. Registrant's Ethnic Background:

Hispanic or Latina

Not Hispanic or Latina

33% of survey complete.

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* 1. Child's First Name:

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* 2. Child's Last Name:

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* 3. Age:

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* 4. Date of Birth:

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* 5. Address:

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* 6. Current School Attending:

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* 7. Parent/Guardian:

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* 8. Parent/Guardian 2:

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

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

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

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* 12. Are you currently a registered Girl Scout?

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

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* 14. Which bus stop will your child use?

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

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* 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.

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* 17. Registrant's Ethnic Background:

* 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.